CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sanford Clear Lake Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $164
Cash Discount Price: $180
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sanford Clear Lake Medical Center is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $180. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.72x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$180

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $180 (189%)

Insurance Median: $164 (172%)

Cash: $180 (189% of Medicare)

Ins. Median: $164 (172% 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
Sanford Health Plan Align	$93 - $137	98%
Security Health Plan	$100 - $147	105%
Ucare	$100 - $235	105%
Wellmark Sd	$100 - $147	105%
Aetna	$101 - $232	106%
Health Partners	$101 - $200	106%
Medicare (plans)	$101 - $148	106%
UnitedHealthcare	$101 - $223	106%
Primewest	$103 - $151	108%
Sanford Health Plan	$126 - $248	132%
Blue Cross Blue Shield	$149 - $247	157%
Medica	$150 - $235	158%
Wellmark	$157 - $232	165%
Cigna	$164 - $240	172%
First Choice Health Network	$164 - $240	172%
Healthez	$164 - $240	172%
Multiplan	$164 - $240	172%

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 $180.
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 Clear Lake 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.