CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: North Memorial Health Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $72
Cash Discount Price: $188
vs. Medicare Baseline: 0.76x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at North Memorial Health Hospital is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.76x the Medicare baseline. Located in 3300 Oakdale North, Robbinsdale, MN.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $188 (197%)

Insurance Median: $72 (76%)

Cash: $188 (197% of Medicare)

Ins. Median: $72 (76% 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
Health Partners [1061]	$48 - $266	50%
Medicaid / KanCare	$48	50%
Blue Cross Blue Shield	$49 - $196	51%
Medica [1086]	$49 - $207	51%
Hennepin Health [1096]	$53 - $54	56%
Ucare [1148]	$58 - $115	61%
Medicare (plans)	$64	67%
UnitedHealthcare	$66 - $176	69%
Aetna	$71	75%
Humana	$71	75%
America'S Ppo [1010]	$136 - $145	143%
Cigna	$277	291%

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 $188.
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 North Memorial Health Hospital 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.