CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Healthone Presbyterian St Luke's

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $288
Cash Discount Price: $510
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Healthone Presbyterian St Luke's is $288. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $510. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.03x the Medicare baseline. Located in 1719 E 19Th Ave, Denver, CO.

Cash / Self-Pay

$510

Average discount available for prompt cash payment at this facility.

Insurance Median

$288

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: $510 (536%)

Insurance Median: $288 (303%)

Cash: $510 (536% of Medicare)

Ins. Median: $288 (303% 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 303% of the Medicare baseline (a markup of 203%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Vail Health	$53 - $209	56%
Kaiser	$69 - $358	72%
United	$72 - $619	76%
Cigna	$100 - $881	105%
Aetna	$104 - $727	109%
Bright Health	$104 - $413	109%
Emerging Therapy Solutions	$166 - $881	174%
Kaiser National Transplant	$166 - $661	174%
Colorado Program For Children With Special Needs	$176 - $702	185%
Western Plains Community Health	$225 - $895	236%
Multiplan	$242 - $1,239	254%
Northcare	$242 - $964	254%
Physician Health Partners	$242 - $964	254%
Blue Cross Blue Shield	$256 - $1,019	269%
Pinnacol Workers Comp	$259 - $1,032	272%
Medical Development International	$277 - $1,101	291%
Triwest Health Alliance	$277 - $1,101	291%
Prime Health	$311 - $1,239	327%

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 $510.
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 HCA Healthone Presbyterian St Luke's 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.