CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sanford Clear Lake Medical Center

Billing Code: 99213 (CPT)

No verified fair price for this procedure here

This hospital only published government or network rates for this billing code — not a standard commercial price — so we can’t show a verified fair-price comparison for it. What it charges each insurer is listed below; call the hospital’s billing office to confirm the actual charge.

modeled estimate · not a bill or quote

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser 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	$101 - $223	106%
Blue Cross Blue Shieldmajor	$100 - $247	105%
Aetnamajor	$101 - $232	106%
Cignamajor	$164 - $240	172%
Health Net	$164 - $240	172%
HealthPartners	$101 - $200	106%
Medica	$150 - $235	158%
Sanford Health Plan	$93 - $248	98%
Security Health Plan	$100 - $147	105%
UCare	$100 - $235	105%
+ 2 smaller / regional plans	$103 - $240

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 180), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Sanford Clear Lake Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Sanford Clear Lake Medical Center

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

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