CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Essentia Health St Mary's Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $89
Cash Discount Price: $103
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Essentia Health St Mary's Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.93x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $103 (108%)

Insurance Median: $89 (93%)

Cash: $103 (108% of Medicare)

Ins. Median: $89 (93% 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
Medica Access	$38 - $65	40%
Healthpartners Care Pmap	$46 - $78	48%
Sanford Health Plan	$49 - $88	51%
Blue Cross Blue Shield	$51 - $149	54%
Blue Plus Pmap Pcc Prime	$51 - $98	54%
Medica	$64 - $111	67%
Medica Uplan	$64 - $108	67%
Healthpartners	$69 - $140	72%
Medica Choice	$70 - $120	74%
Ucare	$76 - $129	80%
Cigna	$82 - $140	86%
Healthpartners Pcc Prime	$82 - $140	86%
Wea	$83 - $151	87%
UnitedHealthcare	$84 - $143	88%
America'S Ppo	$89 - $152	93%
Security Health	$89 - $151	93%
Wps	$95 - $165	100%
Aetna	$98 - $167	103%
Healthscope Benefits	$98 - $167	103%
Healtheos	$99 - $169	104%

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 $103.
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 Essentia Health St Mary's 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.