Skip to main content
States Procedures Methodology Search
CMS Price Transparency Data Hospital file updated: 2026-07-07

Office visit, established patient (30-39 min)

Facility: Appleton Area Health

Billing Code: 99214 (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.High Markup · Shop Alternatives
$150Fair BaseRate (1.63× Market)
Position vs. 1.00× Fair Price+63% 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 $245 compared to the $150 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.High-Markup · Check Safety
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 medium confidence
A fair price for this
$150
about 1.1× the $136 Medicare rate · typically $84–$276
modeled estimate · not a bill or quote
Medicare pays $136 Fair price $150 Cash price $245 Hospital's list price $288

How we calculate the fair BaseRate →

What each insurance company pays

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

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

Blue Cross Blue Shield UnitedHealthcareAetnaCignaHumanaKaiser 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
Blue Cross Blue Shieldmajor $30 - $413 22%

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

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

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 30 S Behl St, Appleton, MN 56208
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals

Other Procedures at Appleton Area Health

Compare: Office visit, established patient (30-39 min) at other MN 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 Appleton Area Health (Zero PHI Required)

CMS CCN: 241341
CPT 99214
Fair BaseRate™ $150
Medicare Rate $136
Self-Pay Cash $245
Insurer Median $173
Pre-filled with Appleton Area Health’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: $105 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $105

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 = $105).

Step 2 · Cash vs. Insurance Arbitrage Save $43 Paying Cash

Self-Pay Cash Rate ($245) Beats Your Bill

Appleton Area Health's published 45 CFR § 180 self-pay cash rate is $245 (vs. $173 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$138 Above Fair BaseRate

Negotiate Toward $150 Fair BaseRate ($136 Medicare)

Your bill ($288) is $138 above the denoised Fair BaseRate ($150) and 2.1× the $136 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.
45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 241341

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 241341) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileReports.aspx
Publication / Vintage2026-07-07 · 2.40 MB
Validated Rate Rows24,411 (CMS v3.0.0)
File Integrity Digestd0cef81be8af053c74fe…

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