Office visit, established patient (20-29 min)
Facility: Mercy Hospital Ada
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $312
- Cash Discount Price: $397
- vs. Medicare Baseline: 3.28x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 328% of the Medicare baseline (a markup of 228%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Healthcare Highways Plus Contracted [320175] | $58 - $2,141 | 61% |
| Aetna | $60 - $2,147 | 63% |
| Blue Cross Blue Shield | $60 | 63% |
| Cherokee Nation Health Serv Contracted [320066] | $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% |
| Humana | $60 - $80 | 63% |
| Independent Health [20197] | $60 | 63% |
| Indian Health Service Contracted [320198] | $60 | 63% |
| Kindful Hospice Contracted [320434] | $60 | 63% |
| Kindful Hospice [20434] | $60 | 63% |
| Medical Associates Health [20444] | $60 | 63% |
| Medicare (plans) | $60 - $2,855 | 63% |
| Mercy Hospice Okc [20252] | $60 | 63% |
| Provider Partners Health Plans Contracted [320450] | $60 | 63% |
| Qual Choice Contracted [320325] | $60 | 63% |
| Tricare | $60 | 63% |
| UnitedHealthcare | $60 - $1,998 | 63% |
| Globalhealth Contracted [320145] | $61 | 64% |
| Cigna | $62 | 65% |
| Webtpa Contracted [320417] | $62 - $1,199 | 65% |
| Osma Health Contracted [320292] | $67 - $1,285 | 70% |
| Medica Contracted [320239] | $69 - $2,855 | 72% |
| Benefit Management Contracted [320052] | $74 - $1,856 | 78% |
| Medicaid / KanCare | $80 - $82 | 84% |
| Ambetter / Centene | $82 | 86% |
| Home State Health Plan Contracted [320187] | $82 | 86% |
| Novasys Contracted [320285] | $82 | 86% |
| Aither Health Contracted [320449] | $89 - $1,713 | 93% |
| Auxiant Contracted [320462] | $89 - $1,713 | 93% |
| Ebms Contracted [320493] | $89 - $1,713 | 93% |
| Federal Medical Center Contracted [320127] | $89 - $1,713 | 93% |
| Healthlink Contracted [320179] | $89 - $1,713 | 93% |
| Healthscope Contracted [320182] | $89 - $1,713 | 93% |
| Imagine 360 Contracted [320494] | $89 - $1,713 | 93% |
| Mercy Benefit Admin Contracted [320251] | $89 - $1,856 | 93% |
| Point C Contracted [320238] | $89 - $1,713 | 93% |
| Preferred Health Plan Contracted [320522] | $89 - $1,713 | 93% |
| Quik Trip Contracted [320447] | $89 - $1,713 | 93% |
| Reflect Health Contracted [320492] | $89 - $1,713 | 93% |
| Show-Me Health Administrators Contracted [320483] | $89 - $1,713 | 93% |
| United Medical Resources Contracted [320454] | $89 - $1,998 | 93% |
| Workers Comp [20426] | $89 - $1,713 | 93% |
| Yuzu Health Contracted [320521] | $89 - $1,713 | 93% |
| Globalhealth Contracted [320144] | $93 - $1,799 | 98% |
| First Health Contracted [320128] | $123 - $2,373 | 129% |
| Multiplan Contracted [320270] | $126 - $2,427 | 132% |
| Private Health Care Systems Contracted [320320] | $126 - $2,427 | 132% |
| Healthsmart Preferred Care Contracted [320184] | $135 | 142% |
| Kempton Contracted [320214] | $135 | 142% |
| Health Choice Contracted [320166] | $140 | 147% |