CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St Lukes Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $83
Cash Discount Price: $193
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Lukes Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.71x the Medicare baseline. Located in 915 East 1St Street, Duluth, MN.

Cash / Self-Pay

$193

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $193 (164%)

Insurance Median: $83 (71%)

Cash: $193 (164% of Medicare)

Ins. Median: $83 (71% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
Ucare	$60 - $78	51%
Blue Cross Blue Shield	$61 - $333	52%
UnitedHealthcare	$61 - $280	52%
Group Health Cooperative Of Eau Claire	$74	63%
Security Health Plan Of Wisconsin, Inc.	$74 - $220	63%
Aetna	$75	64%
Medica	$75 - $292	64%
Healthpartners	$76 - $239	65%
Tricare	$76	65%
Humana	$80 - $93	68%
Multiplan, Inc	$107 - $300	91%
Wps	$220	187%
America'S Ppo	$260	221%

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 $193.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Lukes Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.