CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Essentia Health Virginia

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $89
Cash Discount Price: $72
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Essentia Health Virginia is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.93x the Medicare baseline. Located in 901 9Th Street North, Virginia, MN.

Cash / Self-Pay

$72

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: $72 (76%)

Insurance Median: $89 (93%)

Cash: $72 (76% 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	$26 - $41	27%
Healthpartners Care Pmap	$46 - $71	48%
Sanford Healthplan	$49 - $77	51%
Blue Cross Blue Shield	$52 - $136	55%
Blue Plus Pmap Pcc Prime	$54 - $84	57%
Medica	$73 - $127	77%
Medica Uplan	$73 - $114	77%
Ucare	$76 - $118	80%
Healthpartners	$82 - $162	86%
Wea	$83 - $138	87%
Medica Choice	$84 - $130	88%
America'S Ppo	$89 - $139	93%
Security Health	$89 - $138	93%
Wps	$95 - $150	100%
Aetna	$98 - $152	103%
UnitedHealthcare	$101 - $158	106%
Cigna	$104 - $162	109%
Healthpartners Pcc Prime	$104 - $162	109%

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 $72.
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 Virginia 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.