CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: M Health Fairview St John's Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $273
Cash Discount Price: $152
vs. Medicare Baseline: 2.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at M Health Fairview St John's Hospital is $273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.87x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$273

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: $152 (160%)

Insurance Median: $273 (287%)

Cash: $152 (160% of Medicare)

Ins. Median: $273 (287% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 287% of the Medicare baseline (a markup of 187%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Primewest	$45 - $61	47%
South Country Health Alliance	$45 - $61	47%
Ucare	$46 - $190	48%
UnitedHealthcare	$46 - $208	48%
Health Partners	$49 - $774	51%
Medica	$49 - $292	51%
Blue Cross Blue Shield	$53 - $286	56%
Itasca Medical Care	$53 - $61	56%
Sanford Health Plan	$61 - $224	64%
Security Health Plan	$61 - $286	64%
Wellcare	$61	64%
Hennepin Health	$69	72%
America'S Ppo	$188 - $292	197%
First Health	$288 - $312	303%
Multiplan	$298 - $324	313%
Private Healthcare Systems	$298 - $324	313%
Wisconsin Physician Services	$316 - $343	332%

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 $152.
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 M Health Fairview St John's 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.