CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Marshfield Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $73
Cash Discount Price: $94
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Marshfield Medical Center is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.77x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $94 (99%)

Insurance Median: $73 (77%)

Cash: $94 (99% of Medicare)

Ins. Median: $73 (77% 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
Family Health Center (Fhc)	$33 - $66	35%
Amish/Mennonite	$36 - $73	38%
Sanford Health Plan	$36 - $73	38%
The Alliance	$46 - $110	48%
Blue Cross Blue Shield	$50 - $443	53%
Group Health Cooperative Of Eau Claire	$54 - $121	57%
Besse Forest Products	$56 - $112	59%
Molina Healthcare Of Wi	$56 - $112	59%
Rice Lake School District	$56 - $112	59%
Wps Health Insurance	$58 - $127	61%
Trilogy	$59 - $127	62%
UnitedHealthcare	$60 - $120	63%
Medica Of Wi	$61 - $125	64%
Cigna	$62 - $124	65%
Healtheos By Multiplan Inc.	$62 - $125	65%
Corvel	$63 - $125	66%
Coventry	$63 - $127	66%
First Health	$63 - $125	66%
Health Partners	$63 - $125	66%
Health Smart	$63 - $127	66%
Three Rivers Provider Network (Trpn)	$63 - $125	66%
Rising Medical Work Comp	$64 - $128	67%
Security Health Plan (Shp)	$67 - $98	70%

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 $94.
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 Marshfield 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.