CMS Price Transparency Data
New patient office visit (30-44 min)
Facility: Mercy Hospital Ada
Billing Code: 99203 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99203
- Insurance Median: $204
- Cash Discount Price: $221
- vs. Medicare Baseline: 1.74x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Mercy Hospital Ada is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.74x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.
Cash / Self-Pay
$221
Average discount available for prompt cash payment at this facility.
Insurance Median
$204
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$117.57
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $221 (188%)
Insurance Median: $204 (174%)
Cash: $221 (188% of Medicare)
Ins. Median: $204 (174% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $117.57 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.
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 |
|---|---|---|
| Aetna | $74 - $256 | 63% |
| Blue Cross Blue Shield | $74 | 63% |
| Cherokee Nation Health Serv Contracted [320066] | $74 | 63% |
| Cross Timbers Hospice [20098] | $74 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $74 | 63% |
| Elara Caring Aspire Hospice Contracted [320433] | $74 | 63% |
| Elara Caring Aspire Hospice [20433] | $74 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $74 | 63% |
| Halo Hcr Inc Hospice [20432] | $74 | 63% |
| Humana | $74 - $98 | 63% |
| Independent Health [20197] | $74 | 63% |
| Indian Health Service Contracted [320198] | $74 | 63% |
| Kindful Hospice Contracted [320434] | $74 | 63% |
| Kindful Hospice [20434] | $74 | 63% |
| Medical Associates Health [20444] | $74 | 63% |
| Medicare (plans) | $74 - $340 | 63% |
| Mercy Hospice Okc [20252] | $74 | 63% |
| Provider Partners Health Plans Contracted [320450] | $74 | 63% |
| Qual Choice Contracted [320325] | $74 | 63% |
| Tricare | $74 | 63% |
| UnitedHealthcare | $74 - $238 | 63% |
| Globalhealth Contracted [320145] | $76 | 65% |
| Cigna | $77 | 65% |
| Medicaid / KanCare | $98 - $102 | 83% |
| Ambetter / Centene | $102 | 87% |
| Home State Health Plan Contracted [320187] | $102 | 87% |
| Novasys Contracted [320285] | $102 | 87% |
| Healthcare Highways Plus Contracted [320175] | $133 - $255 | 113% |
| Webtpa Contracted [320417] | $143 | 122% |
| Osma Health Contracted [320292] | $153 | 130% |
| Medica Contracted [320239] | $158 - $340 | 134% |
| Healthsmart Preferred Care Contracted [320184] | $167 | 142% |
| Kempton Contracted [320214] | $167 | 142% |
| Benefit Management Contracted [320052] | $170 - $221 | 145% |
| Health Choice Contracted [320166] | $171 | 145% |
| Aither Health Contracted [320449] | $204 | 174% |
| Auxiant Contracted [320462] | $204 | 174% |
| Ebms Contracted [320493] | $204 | 174% |
| Federal Medical Center Contracted [320127] | $204 | 174% |
| Healthlink Contracted [320179] | $204 | 174% |
| Healthscope Contracted [320182] | $204 | 174% |
| Imagine 360 Contracted [320494] | $204 | 174% |
| Mercy Benefit Admin Contracted [320251] | $204 - $221 | 174% |
| Point C Contracted [320238] | $204 | 174% |
| Preferred Health Plan Contracted [320522] | $204 | 174% |
| Quik Trip Contracted [320447] | $204 | 174% |
| Reflect Health Contracted [320492] | $204 | 174% |
| Show-Me Health Administrators Contracted [320483] | $204 | 174% |
| United Medical Resources Contracted [320454] | $204 - $238 | 174% |
| Workers Comp [20426] | $204 | 174% |
| Yuzu Health Contracted [320521] | $204 | 174% |
| Globalhealth Contracted [320144] | $214 | 182% |
| First Health Contracted [320128] | $283 | 241% |
| Multiplan Contracted [320270] | $289 | 246% |
| Private Health Care Systems Contracted [320320] | $289 | 246% |