CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Francis Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $120
Cash Discount Price: $80
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Francis Regional Medical Center is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.26x the Medicare baseline. Located in 1455 St Francis Avenue, Shakopee, MN.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $80 (84%)

Insurance Median: $120 (126%)

Cash: $80 (84% of Medicare)

Ins. Median: $120 (126% 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
Ucare Pmap (A B C D E G N O S U R H)	$29 - $40	30%
Aetna	$64 - $119	67%
Medicaid / KanCare	$69	72%
South Country Health Alliance	$71	75%
Medica Health System	$73 - $161	77%
Americas Ppo (Araz)(B D N O R S V)	$110 - $154	116%
Medica	$110 - $153	116%
Medica Mhps	$110 - $153	116%
Americas Ppo (Araz) (B D N H O R S)	$120 - $168	126%
First Health (A C E G H U B D N O R S)	$120 - $168	126%
Health Partners	$125 - $149	131%
Blue Cross Blue Shield	$127 - $409	133%
UnitedHealthcare	$129 - $199	136%
Cigna	$139 - $372	146%
All Other Contracted Care (A B C D E G H N O R S U)	$143 - $199	150%

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 $80.
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 Francis Regional 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.