CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Oklahoma City, Inc
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $267
- Cash Discount Price: $289
- vs. Medicare Baseline: 2.80x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Oklahoma City, Inc is $267. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $289. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.80x the Medicare baseline. Located in 4300 West Memorial Road, Oklahoma City, OK.
Cash / Self-Pay
$289
Average discount available for prompt cash payment at this facility.
Insurance Median
$267
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$95.19
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $289 (304%)
Insurance Median: $267 (280%)
Cash: $289 (304% of Medicare)
Ins. Median: $267 (280% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 280% of the Medicare baseline (a markup of 180%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $13 - $82 | 14% |
| Medica Contracted [320239] | $22 - $413 | 23% |
| Healthcare Highways Plus Contracted [320175] | $27 - $782 | 28% |
| Webtpa Contracted [320417] | $29 - $548 | 30% |
| Osma Health Contracted [320292] | $31 - $587 | 33% |
| Cigna | $36 - $780 | 38% |
| Aither Health Contracted [320449] | $41 - $782 | 43% |
| Auxiant Contracted [320462] | $41 - $848 | 43% |
| Benefit Management Contracted [320052] | $41 - $848 | 43% |
| Ebms Contracted [320493] | $41 - $782 | 43% |
| Healthlink Contracted [320179] | $41 - $848 | 43% |
| Imagine 360 Contracted [320494] | $41 - $782 | 43% |
| Mercy Benefit Admin Contracted [320251] | $41 - $848 | 43% |
| Quik Trip Contracted [320447] | $41 - $782 | 43% |
| Reflect Health Contracted [320492] | $41 - $782 | 43% |
| Show-Me Health Administrators Contracted [320483] | $41 - $782 | 43% |
| Workers Comp [20426] | $41 - $782 | 43% |
| Yuzu Health Contracted [320521] | $41 - $782 | 43% |
| Aetna | $42 - $943 | 44% |
| First Health Contracted [320128] | $42 - $803 | 44% |
| Federal Medical Center Contracted [320127] | $44 - $848 | 46% |
| Healthscope Contracted [320182] | $44 - $848 | 46% |
| Healthsmart Accel Contracted [320183] | $44 - $848 | 46% |
| Healthsmart Preferred Care Contracted [320184] | $44 - $848 | 46% |
| Point C Contracted [320238] | $44 - $848 | 46% |
| Preferred Health Plan Contracted [320522] | $44 - $848 | 46% |
| Private Health Care Systems Contracted [320320] | $44 - $913 | 46% |
| Tri State Healthcare Coalition Contracted [320379] | $44 - $848 | 46% |
| United Medical Resources Contracted [320454] | $44 - $848 | 46% |
| UnitedHealthcare | $44 - $468 | 46% |
| Humana | $47 - $900 | 49% |
| Community Care Contracted [320080] | $48 - $913 | 50% |
| Globalhealth Contracted [320144] | $48 - $926 | 50% |
| Multiplan Contracted [320270] | $48 - $1,174 | 50% |
| Preferred Community Choice Contracted [320311] | $52 - $991 | 55% |
| Tricare | $57 - $60 | 60% |
| Blue Cross Blue Shield | $60 | 63% |
| Champva [20065] | $60 | 63% |
| Cross Timbers Hospice [20098] | $60 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $60 | 63% |
| Elara Caring Aspire Hospice Contracted [320433] | $60 | 63% |
| Elara Caring Aspire Hospice [20433] | $60 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $60 | 63% |
| Halo Hcr Inc Hospice [20432] | $60 | 63% |
| Kindful Hospice Contracted [320434] | $60 | 63% |
| Kindful Hospice [20434] | $60 | 63% |
| Longevity Health Plan [10477] | $60 | 63% |
| Medicare (plans) | $60 - $64 | 63% |
| Mercy Hospice Okc [20252] | $60 | 63% |
| Mercy Rehab Hospital Contracted [320260] | $60 | 63% |
| Provider Partners Health Plans Contracted [320450] | $60 | 63% |
| Qual Choice Contracted [320325] | $60 | 63% |
| Globalhealth Contracted [320145] | $61 | 64% |
| Cherokee Nation Health Serv Contracted [320066] | $62 | 65% |
| Indian Health Service Contracted [320198] | $62 | 65% |
| Amg Spec Hosp Edmond [20034] | $64 | 67% |
| Centralink Contracted [320480] | $68 - $1,304 | 71% |
| Ambetter / Centene | $82 | 86% |
| Home State Health Plan Contracted [320187] | $82 | 86% |
| Novasys Contracted [320285] | $82 | 86% |
| Health Choice Contracted [320166] | $127 | 133% |
| Kempton Contracted [320214] | $135 | 142% |