CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mercy Hospital Marietta

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $123
Cash Discount Price: $205
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Marietta is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.29x the Medicare baseline. Located in 300 Wanda Street, Marietta, OK.

Cash / Self-Pay

$205

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: $205 (215%)

Insurance Median: $123 (129%)

Cash: $205 (215% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$66 - $143	69%
Blue Cross Blue Shield	$66 - $94	69%
Cross Timbers Hospice [20098]	$66	69%
Elara Caring Aspire Hospice Contracted [320433]	$66	69%
Elara Caring Aspire Hospice [20433]	$66	69%
Halo Hcr Inc Hospice Contracted [320432]	$66	69%
Halo Hcr Inc Hospice [20432]	$66	69%
Humana	$66 - $80	69%
Independent Health [20197]	$66	69%
Indian Health Service Contracted [320198]	$66	69%
Kindful Hospice Contracted [320434]	$66	69%
Kindful Hospice [20434]	$66	69%
Medical Associates Health [20444]	$66	69%
Medicare (plans)	$66 - $70	69%
Mercy Hospice Okc [20252]	$66	69%
Tricare	$70	74%
UnitedHealthcare	$70 - $144	74%
Cigna	$73 - $154	77%
Medicaid / KanCare	$80	84%
Webtpa Contracted [320417]	$86	90%
Aither Health Contracted [320449]	$123 - $174	129%
Mercy Benefit Admin Contracted [320251]	$123 - $184	129%
Quik Trip Contracted [320447]	$123	129%
Show-Me Health Administrators Contracted [320483]	$123	129%
Osma Health Contracted [320292]	$144	151%
United Medical Resources Contracted [320454]	$144 - $184	151%
First Health Contracted [320128]	$145	152%
Benefit Management Contracted [320052]	$154 - $184	162%
Healthcare Highways Plus Contracted [320175]	$154	162%
Auxiant Contracted [320462]	$174 - $184	183%
Ebms Contracted [320493]	$174	183%
Healthlink Contracted [320179]	$174 - $184	183%
Preferred Community Choice Contracted [320311]	$174	183%
Federal Medical Center Contracted [320127]	$184	193%
Healthscope Contracted [320182]	$184	193%
Point C Contracted [320238]	$184	193%
Preferred Health Plan Contracted [320522]	$184	193%
Tri State Healthcare Coalition Contracted [320379]	$184	193%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $205.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Marietta is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.