CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Perham Health

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $65
Cash Discount Price: $76
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Perham Health is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.68x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $76 (80%)

Insurance Median: $65 (68%)

Cash: $76 (80% of Medicare)

Ins. Median: $65 (68% 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	$28 - $150	29%
Medica Mcaid Mn Care	$33 - $81	35%
Health Partners Mcr Adv	$34 - $93	36%
Humana	$34 - $75	36%
Medica Mcr Adv	$34 - $75	36%
Medicare (plans)	$34 - $84	36%
Ucare Mn Senior Health Options	$34 - $75	36%
Ucare Mn Special Needs Basic Care Dual	$35 - $79	37%
UnitedHealthcare	$35 - $172	37%
Medicaid / KanCare	$36 - $137	38%
Ucare Mn Medical Assistance	$36 - $80	38%
Ucare Mn Minnesota Care	$36 - $80	38%
Ucare Mn Senior Care Plus	$36 - $80	38%
Ucare Mn Special Needs Basic Care	$36 - $80	38%
Medica Mn (Msho)	$37 - $91	39%
Ucare Individual And Family Plan-All Other Plans	$41 - $91	43%
Health Partners Minnesota Care	$44 - $110	46%
Medica Mn Senior Hp/Outside Mn	$45 - $68	47%
Medica Commercial-All Other Plans	$65 - $162	68%
Health Partners-All Plans	$73 - $181	77%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$75 - $166	79%
Preferred One (Ppo)	$76 - $188	80%
Sanford Health Plan-All Plans	$85 - $188	89%

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 $76.
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 Perham Health 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.