CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Luke's McCall

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $283
Cash Discount Price: $322
vs. Medicare Baseline: 2.97x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Luke's McCall is $283. 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 2.97x the Medicare baseline. Located in 1000 State Street, McCall, ID.

Cash / Self-Pay

$322

Average discount available for prompt cash payment at this facility.

Insurance Median

$283

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: $283 (297%)

Cash: $322 (338% of Medicare)

Ins. Median: $283 (297% 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 297% of the Medicare baseline (a markup of 197%). 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
Commercial [1028]	$187 - $309	196%
Medicare (plans)	$187 - $190	196%
Veterans Affairs [1056]	$187	196%
Blue Cross Blue Shield	$189 - $283	199%
Aetna	$205 - $306	215%
Moda [1055]	$283	297%
Pacificsource [1020]	$303	318%
First Health [1064]	$306	321%
Webtpa [1071]	$306	321%
Geha [1065]	$309	325%
United Medical Resources [1051]	$309	325%
UnitedHealthcare	$309	325%

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 McCall 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.