CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Luke's Nampa Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $258
Cash Discount Price: $322
vs. Medicare Baseline: 2.71x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Luke's Nampa Medical Center is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $322. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.71x the Medicare baseline. Located in 9850 West St Lukes Drive, Nampa, ID.

Cash / Self-Pay

$322

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $322 (338%)

Insurance Median: $258 (271%)

Cash: $322 (338% of Medicare)

Ins. Median: $258 (271% 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 271% of the Medicare baseline (a markup of 171%). 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
UnitedHealthcare	$56 - $264	59%
Blue Cross Blue Shield	$209 - $275	220%
Commercial [1028]	$209 - $290	220%
Mountain Health Co-Op [1067]	$209	220%
Pacificsource [1020]	$209 - $242	220%
Select Health [1063]	$209	220%
Slplan Tap Mc St Lukes Health Plan [1641000001]	$209	220%
St Lukes Health Plan [1046]	$209	220%
Aetna	$258	271%
Webtpa [1071]	$258 - $274	271%
Geha [1065]	$264	277%
United Medical Resources [1051]	$264	277%
First Health [1064]	$266 - $274	279%

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 $322.
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 St Luke's Nampa Medical Center 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.