CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Ortonville Area Health Services

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $26
Cash Discount Price: $30
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Ortonville Area Health Services is $26. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.27x the Medicare baseline. Located in 450 Eastvold Ave, Ortonville, MN.

Cash / Self-Pay

$30

Average discount available for prompt cash payment at this facility.

Insurance Median

$26

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: $30 (32%)

Insurance Median: $26 (27%)

Cash: $30 (32% of Medicare)

Ins. Median: $26 (27% 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	$13 - $34	14%
Medica	$17	18%
Medica Minnesota Senior Health Options (Msho)/Select Solution/Prime Solution	$17	18%
Primewest	$17	18%
Ucare Health	$17	18%
UnitedHealthcare	$17 - $31	18%
Health Partners	$18 - $31	19%
Medica Choicecare/Accessibility Solution/Minnesotacare	$21	22%
Sanford Health Plan	$32	34%
Multiplan	$33	35%
America'S Health System	$34	36%
Medica Choice/Focus/Ifb/Mhps/Care System	$34	36%

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 $30.
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 Ortonville Area Health Services 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.