CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Clearwater Valley Hospital & Clinics

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $84
Cash Discount Price: $90
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Clearwater Valley Hospital & Clinics is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.88x the Medicare baseline. Located in 301 Cedar Street, Orofino, ID.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $90 (95%)

Insurance Median: $84 (88%)

Cash: $90 (95% of Medicare)

Ins. Median: $84 (88% 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	$38 - $144	40%
Blue Cross Blue Shield	$38 - $152	40%
Humana	$38 - $179	40%
Nimiipuu Mcr Adv-All Plans	$38 - $85	40%
Pacific Source - All Plans	$38 - $212	40%
Regence Blue Shield Mcr	$38 - $84	40%
Veterans Amin-All Plans	$38 - $84	40%
Corizon Correctnal Med-All Plans	$51 - $113	54%
Idaho Phys Network-All Plans	$66 - $288	69%
Multiplan / Phcs-All Plans	$68 - $291	71%
First Choice-All Plans	$69 - $297	72%
Geha-All Plans	$69 - $294	72%
Regence Blue Shield-All Other Plans	$70 - $155	74%
UnitedHealthcare	$85	89%
Cigna	$127	133%

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 $90.
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 Clearwater Valley Hospital & Clinics 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.