Office visit, established patient (20-29 min)
Facility: Childrens Hospital of Wisconsin
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $103
- Cash Discount Price: $63
- vs. Medicare Baseline: 1.08x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical College of Wisconsin | $59 - $307 | 62% |
| Froedtert Health | $59 - $373 | 62% |
| UnitedHealthcare | $60 - $334 | 63% |
| Network Health Plan | $60 - $329 | 63% |
| Trilogy Health Solutions | $63 - $373 | 66% |
| Common Ground Healthcare Cooperative | $63 - $373 | 66% |
| Aspirus Health Plan | $63 - $329 | 66% |
| Chorus Community Health Plan | $64 | 67% |
| Wps Health Plan | $64 - $395 | 67% |
| Managed Health Services | $65 | 68% |
| Advocate Aurora Healthcare | $65 - $338 | 68% |
| Molina Healthcare of Wisconsin | $65 | 68% |
| Employer Health Care Alliance Cooperative | $66 - $345 | 69% |
| Health Partners | $66 - $386 | 69% |
| Icare | $66 | 69% |
| Centivo | $66 - $342 | 69% |
| Blue Cross Blue Shield | $66 - $417 | 69% |
| My Choice Wisconsin | $66 | 69% |
| Oan LLC | $67 - $351 | 70% |
| Group Health Cooperative of Eau Claire | $67 - $351 | 70% |
| Dean Health Plan | $67 - $351 | 70% |
| Security Health Plan | $70 - $364 | 74% |
| Quartz Health Insurance | $71 - $373 | 75% |
| Praire States | $71 - $373 | 75% |
| Sheboygan Employer's Health Network | $71 - $373 | 75% |
| Health Payment Systems | $71 - $371 | 75% |
| Mayo Clinic Health Solutions | $73 - $382 | 77% |
| Aetna | $74 - $391 | 78% |
| Group Health Cooperative of South Central Wisconsin | $76 - $395 | 80% |
| Prevea Health Network | $76 - $395 | 80% |
| Bellin Thedacare | $76 - $395 | 80% |
| Multiplan | $76 - $417 | 80% |
| Cigna | $76 - $395 | 80% |
| Coventry Health Care | $80 - $417 | 84% |
| Quartz Health Solutions | $329 | 346% |
| Healthsmart Payers Organization | $348 | 366% |
| Health Payers Organization | $368 | 387% |