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CMS Price Transparency Data Hospital file updated: 2026-10-01

Office visit, established patient (20-29 min)

Facility: Sioux Falls Specialty Hospital

Billing Code: 99213 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
$103Fair BaseRate (1.14× Market)
Position vs. 1.00× Fair Price+14% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $117 compared to the $103 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

The BaseRate · fair price high confidence
A fair price for this
$103
about 1.1× the $95 Medicare rate · typically $67–$125
modeled estimate · not a bill or quote
What this hospital charges insurers
$117
About the fair price
about $14 over the fair price · 1.2× Medicare
Medicare pays $95 Fair price $103 This hospital $117 Cash price $145 Hospital's list price $193

How we calculate the fair BaseRate →

How this hospital compares to other SD hospitals

Highest price of the 9 SD hospitals we have prices for — worth calling around.

Cheapest $71 Priciest $117

Black dot = this hospital, among the 9 SD hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $103 (about 1.1× the $95 Medicare rate). Sioux Falls Specialty Hospital charges insurers about $117, or about $145 in cash — about the fair price. Located in Sioux Falls, SD.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldAetnaCignaHumana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $102 - $174 107%
Blue Cross Blue Shieldmajor $117 123%
Aetnamajor $77 81%
Cignamajor $164 172%
Humanamajor $174 183%
GEHA $159 167%
HealthPartners $129 136%
Medica $174 183%
+ 90 smaller / regional plans $77 - $174
Excludes 8 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 910 East 20Th Street, Sioux Falls, SD 57105
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals

Other Procedures at Sioux Falls Specialty Hospital

Compare: Office visit, established patient (20-29 min) at other SD hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Sioux Falls Specialty Hospital (Zero PHI Required)

CMS CCN: 430090
CPT 99213
Fair BaseRate™ $103
Medicare Rate $95
Self-Pay Cash $145
Insurer Median $117
Pre-filled with Sioux Falls Specialty Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $70 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $70

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $70).

Step 2 · Cash vs. Insurance Arbitrage Save $48 Paying Cash

Self-Pay Cash Rate ($145) Beats Your Bill

Sioux Falls Specialty Hospital's published 45 CFR § 180 self-pay cash rate is $145 (vs. $117 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$90 Above Fair BaseRate

Negotiate Toward $103 Fair BaseRate ($95 Medicare)

Your bill ($193) is $90 above the denoised Fair BaseRate ($103) and 2.0× the $95 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 430090

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (460382492_Sioux-Falls-Specialty-Hospital_standardcharges.csv) Verify on CMS Medicare.gov (CCN 430090) ↗ CMS HCRIS Cost Reports ↗
Published MRF File460382492_Sioux-Falls-Specialty-Hospital_standardcharges.csv
Publication / Vintage2026-10-01 · 50.47 MB
Validated Rate Rows1,861,082 (CMS v3.0.0)
File Integrity Digest84d48a186c6968a538cb…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy