CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Josephs Community Hospital West Bend

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $161
Cash Discount Price: $98
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Josephs Community Hospital West Bend is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.69x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $98 (103%)

Insurance Median: $161 (169%)

Cash: $98 (103% of Medicare)

Ins. Median: $161 (169% 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
Sheboygan Employers Health Network	$57	60%
Allwell	$85	89%
Blue Cross Blue Shield	$85	89%
Community Care	$85	89%
Health Partners	$85 - $221	89%
Humana	$85	89%
Icare	$85	89%
Molina	$85	89%
Network Health Plan	$85 - $207	89%
Security Health Plan Secure Savers	$85	89%
UnitedHealthcare	$85	89%
Aetna	$87 - $238	91%
Care Wisconsin	$87	91%
Common Ground	$107 - $204	112%
Health Payment Systems	$113 - $275	119%
Wisconsin Physician Services	$143 - $272	150%
Trilogy	$147 - $279	154%
Americas Choice	$156 - $296	164%
Healtheos	$156 - $296	164%
Multiplan/Private Healthcare Systems	$156 - $296	164%
First Health Network	$158 - $299	166%
Hfn	$161 - $306	169%
Ibsi Passport	$161 - $306	169%
Cigna	$170 - $323	179%
Healthsmart	$170 - $323	179%

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 $98.
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 St Josephs Community Hospital West Bend 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.