CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy St Francis Hospital
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $192
- Cash Discount Price: $143
- vs. Medicare Baseline: 2.02x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy St Francis Hospital is $192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.02x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.
Cash / Self-Pay
$143
Average discount available for prompt cash payment at this facility.
Insurance Median
$192
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: $143 (150%)
Insurance Median: $192 (202%)
Cash: $143 (150% of Medicare)
Ins. Median: $192 (202% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 202% of the Medicare baseline (a markup of 102%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $50 - $124 | 53% |
| UnitedHealthcare | $55 - $226 | 58% |
| Dept of Veteran Affairs Contracted [320106] | $56 - $82 | 59% |
| Medical Associates Health Contracted [320444] | $56 - $82 | 59% |
| Kindful Hospice [20434] | $56 - $82 | 59% |
| Pace of the Ozarks Contracted [320518] | $56 - $82 | 59% |
| Globalhealth Contracted [320145] | $56 - $82 | 59% |
| Cigna | $56 - $226 | 59% |
| Healthscope Contracted [320182] | $56 - $109 | 59% |
| Cherokee Nation Health Serv Contracted [320066] | $56 - $82 | 59% |
| Indian Health Service Contracted [320198] | $56 - $82 | 59% |
| Medicare (plans) | $56 - $85 | 59% |
| Halo Hcr Inc Hospice [20432] | $56 - $82 | 59% |
| Mercy Hospice Okc [20252] | $56 - $82 | 59% |
| Aetna | $56 - $212 | 59% |
| Mercy Mgd Behavioral Health Contracted [320259] | $56 - $82 | 59% |
| Blue Cross Blue Shield | $56 - $231 | 59% |
| Qual Choice Contracted [320325] | $56 - $82 | 59% |
| Elara Caring Aspire Hospice [20433] | $56 - $82 | 59% |
| Humana | $56 - $214 | 59% |
| Provider Partners Health Plans Contracted [320450] | $56 - $82 | 59% |
| Halo Hcr Inc Hospice Contracted [320432] | $56 - $82 | 59% |
| Kindful Hospice Contracted [320434] | $56 - $82 | 59% |
| Acentra Health Contracted [320527] | $56 - $65 | 59% |
| Cross Timbers Hospice [20098] | $56 - $82 | 59% |
| Tricare | $69 - $81 | 72% |
| Administrative Payor Contracted [320005] | $91 - $107 | 96% |
| Centivo Contracted [320505] | $92 - $138 | 97% |
| Home State Health Plan Contracted [320187] | $105 - $124 | 110% |
| Ambetter / Centene | $105 - $124 | 110% |
| Novasys Contracted [320285] | $105 - $124 | 110% |
| Preferred Health Plan Contracted [320522] | $131 - $155 | 138% |
| Healthlink Contracted [320179] | $131 - $226 | 138% |
| Workers Comp [20426] | $162 - $202 | 170% |
| Mercy Benefit Admin Contracted [320251] | $182 - $226 | 191% |
| Auxiant Contracted [320462] | $182 - $226 | 191% |
| United Medical Resources Contracted [320454] | $182 - $221 | 191% |
| Point C Contracted [320238] | $182 - $226 | 191% |
| Medica Contracted [320239] | $191 - $225 | 201% |
| Yuzu Health Contracted [320521] | $192 - $226 | 202% |
| Edison Health Solutions Contracted [320502] | $192 - $226 | 202% |
| Aither Health Contracted [320449] | $192 - $226 | 202% |
| Reflect Health Contracted [320492] | $192 - $226 | 202% |
| Health Systems Inc Contracted [320174] | $192 - $226 | 202% |
| Point C [20238] | $192 - $226 | 202% |
| Imagine 360 Contracted [320494] | $192 - $226 | 202% |
| Multiplan Contracted [320270] | $192 - $226 | 202% |
| Insurance System Inc Contracted [320465] | $192 - $226 | 202% |
| Ebms Contracted [320493] | $192 - $226 | 202% |
| Evolutions Health Care Contracted [320124] | $192 - $226 | 202% |
| Show-Me Health Administrators Contracted [320483] | $192 - $226 | 202% |
| First Health Contracted [320128] | $192 - $226 | 202% |
| 90 Degree Benefits Contracted [320436] | $192 - $226 | 202% |
| Benefit Management Contracted [320052] | $192 - $226 | 202% |
| Private Health Care Systems Contracted [320320] | $192 - $226 | 202% |
| USA Managed Care Org Contracted [320429] | $192 - $226 | 202% |