CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Tishomingo Inc
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $123
- Cash Discount Price: $133
- vs. Medicare Baseline: 1.29x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Tishomingo Inc is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.29x the Medicare baseline. Located in 1000 South Byrd St, Tishomingo, OK.
Cash / Self-Pay
$133
Average discount available for prompt cash payment at this facility.
Insurance Median
$123
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: $133 (140%)
Insurance Median: $123 (129%)
Cash: $133 (140% of Medicare)
Ins. Median: $123 (129% 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.
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 |
|---|---|---|
| Ambetter / Centene | $62 | 65% |
| Home State Health Plan Contracted [320187] | $62 | 65% |
| Medicaid / KanCare | $62 - $80 | 65% |
| Novasys Contracted [320285] | $62 | 65% |
| Blue Cross Blue Shield | $66 - $99 | 69% |
| Aetna | $80 - $136 | 84% |
| Humana | $80 - $164 | 84% |
| Webtpa Contracted [320417] | $86 | 90% |
| Medicare (plans) | $95 - $131 | 100% |
| Cherokee Nation Health Serv Contracted [320066] | $99 | 104% |
| Cross Timbers Hospice [20098] | $99 | 104% |
| Dept Of Veteran Affairs Contracted [320106] | $99 | 104% |
| Elara Caring Aspire Hospice Contracted [320433] | $99 | 104% |
| Elara Caring Aspire Hospice [20433] | $99 | 104% |
| Halo Hcr Inc Hospice Contracted [320432] | $99 | 104% |
| Halo Hcr Inc Hospice [20432] | $99 | 104% |
| Independent Health [20197] | $99 | 104% |
| Indian Health Service Contracted [320198] | $99 | 104% |
| Kindful Hospice Contracted [320434] | $99 | 104% |
| Kindful Hospice [20434] | $99 | 104% |
| Medical Associates Health [20444] | $99 | 104% |
| Mercy Hospice Okc [20252] | $99 | 104% |
| Provider Partners Health Plans Contracted [320450] | $99 | 104% |
| Qual Choice Contracted [320325] | $99 | 104% |
| Tribute Health Plan Mcr Contracted [320338] | $99 | 104% |
| Tricare | $99 | 104% |
| UnitedHealthcare | $99 - $162 | 104% |
| Globalhealth Contracted [320145] | $101 | 106% |
| Cigna | $102 - $154 | 107% |
| Aither Health Contracted [320449] | $123 - $174 | 129% |
| Mercy Benefit Admin Contracted [320251] | $123 - $174 | 129% |
| Quik Trip Contracted [320447] | $123 | 129% |
| Show-Me Health Administrators Contracted [320483] | $123 | 129% |
| Medica Contracted [320239] | $131 | 138% |
| First Health Contracted [320128] | $136 | 143% |
| Health Choice Contracted [320166] | $140 | 147% |
| Osma Health Contracted [320292] | $144 | 151% |
| Benefit Management Contracted [320052] | $154 - $184 | 162% |
| Healthcare Highways Plus Contracted [320175] | $154 | 162% |
| Private Health Care Systems Contracted [320320] | $154 - $164 | 162% |
| United Medical Resources Contracted [320454] | $162 | 170% |
| Multiplan Contracted [320270] | $164 - $184 | 172% |
| Auxiant Contracted [320462] | $174 | 183% |
| Ebms Contracted [320493] | $174 | 183% |
| Healthlink Contracted [320179] | $174 | 183% |
| Imagine 360 Contracted [320494] | $174 | 183% |
| Preferred Community Choice Contracted [320311] | $174 | 183% |
| Reflect Health Contracted [320492] | $174 | 183% |
| Yuzu Health Contracted [320521] | $174 | 183% |