CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Lukes Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $78
Cash Discount Price: $139
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Lukes Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.82x the Medicare baseline. Located in 915 East 1St Street, Duluth, MN.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $139 (146%)

Insurance Median: $78 (82%)

Cash: $139 (146% of Medicare)

Ins. Median: $78 (82% 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
Blue Cross Blue Shield	$49 - $268	51%
Humana	$54 - $78	57%
Ucare	$54 - $64	57%
Group Health Cooperative Of Eau Claire	$60	63%
Security Health Plan Of Wisconsin, Inc.	$60 - $221	63%
UnitedHealthcare	$60 - $186	63%
Aetna	$61	64%
Medica	$61 - $221	64%
Healthpartners	$62 - $172	65%
Tricare	$62	65%
Multiplan, Inc	$88 - $114	92%
Cigna	$161	169%
America'S Ppo	$195	205%
Wps	$207	217%
First Health Group Corp	$221	232%

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 $139.
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 Lukes 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.