CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sanford Westbrook Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $150
Cash Discount Price: $168
vs. Medicare Baseline: 1.58x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sanford Westbrook Medical Center is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.58x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $168 (176%)

Insurance Median: $150 (158%)

Cash: $168 (176% of Medicare)

Ins. Median: $150 (158% 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	$40 - $234	42%
Sanford Health Plan Align	$71 - $108	75%
Aetna	$77 - $220	81%
Health Partners	$77 - $202	81%
Medicare (plans)	$77 - $117	81%
Ucare	$77 - $222	81%
UnitedHealthcare	$77 - $211	81%
Wellmark Sd	$77 - $116	81%
Primewest	$79 - $128	83%
Security Health Plan	$92 - $139	97%
Sanford Health Plan	$132 - $235	139%
Medica	$147 - $239	154%
Cigna	$150 - $228	158%
First Choice Health Network	$150 - $228	158%
Healthez	$150 - $228	158%
Multiplan	$150 - $228	158%

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 $168.
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 Sanford Westbrook 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.