CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Mercy Hospital Tishomingo Inc
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $158
- Cash Discount Price: $171
- vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Mercy Hospital Tishomingo Inc is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.17x the Medicare baseline. Located in 1000 South Byrd St, Tishomingo, OK.
Cash / Self-Pay
$171
Average discount available for prompt cash payment at this facility.
Insurance Median
$158
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $171 (126%)
Insurance Median: $158 (117%)
Cash: $171 (126% of Medicare)
Ins. Median: $158 (117% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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 | $79 | 58% |
| Home State Health Plan Contracted [320187] | $79 | 58% |
| Medicaid / KanCare | $79 - $113 | 58% |
| Novasys Contracted [320285] | $79 | 58% |
| Blue Cross Blue Shield | $84 - $126 | 62% |
| Webtpa Contracted [320417] | $110 | 81% |
| Aetna | $113 - $175 | 83% |
| Humana | $113 - $210 | 83% |
| Medicare (plans) | $121 - $168 | 89% |
| Cherokee Nation Health Serv Contracted [320066] | $126 | 93% |
| Cross Timbers Hospice [20098] | $126 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $126 | 93% |
| Elara Caring Aspire Hospice Contracted [320433] | $126 | 93% |
| Elara Caring Aspire Hospice [20433] | $126 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $126 | 93% |
| Halo Hcr Inc Hospice [20432] | $126 | 93% |
| Independent Health [20197] | $126 | 93% |
| Indian Health Service Contracted [320198] | $126 | 93% |
| Kindful Hospice Contracted [320434] | $126 | 93% |
| Kindful Hospice [20434] | $126 | 93% |
| Medical Associates Health [20444] | $126 | 93% |
| Mercy Hospice Okc [20252] | $126 | 93% |
| Provider Partners Health Plans Contracted [320450] | $126 | 93% |
| Qual Choice Contracted [320325] | $126 | 93% |
| Tribute Health Plan Mcr Contracted [320338] | $126 | 93% |
| Tricare | $126 | 93% |
| UnitedHealthcare | $126 - $208 | 93% |
| Globalhealth Contracted [320145] | $129 | 95% |
| Cigna | $130 - $197 | 96% |
| Aither Health Contracted [320449] | $158 - $224 | 117% |
| Mercy Benefit Admin Contracted [320251] | $158 - $224 | 117% |
| Quik Trip Contracted [320447] | $158 | 117% |
| Show-Me Health Administrators Contracted [320483] | $158 | 117% |
| Medica Contracted [320239] | $168 | 124% |
| First Health Contracted [320128] | $175 | 129% |
| Osma Health Contracted [320292] | $184 | 136% |
| Benefit Management Contracted [320052] | $197 - $237 | 145% |
| Health Choice Contracted [320166] | $197 | 145% |
| Healthcare Highways Plus Contracted [320175] | $197 | 145% |
| Private Health Care Systems Contracted [320320] | $197 - $210 | 145% |
| United Medical Resources Contracted [320454] | $208 | 153% |
| Multiplan Contracted [320270] | $210 - $237 | 155% |
| Auxiant Contracted [320462] | $224 | 165% |
| Ebms Contracted [320493] | $224 | 165% |
| Healthlink Contracted [320179] | $224 | 165% |
| Imagine 360 Contracted [320494] | $224 | 165% |
| Preferred Community Choice Contracted [320311] | $224 | 165% |
| Reflect Health Contracted [320492] | $224 | 165% |
| Yuzu Health Contracted [320521] | $224 | 165% |