CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Gundersen Lutheran Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $107
Cash Discount Price: $49
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Gundersen Lutheran Medical Center is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.12x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$107

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: $49 (51%)

Insurance Median: $107 (112%)

Cash: $49 (51% of Medicare)

Ins. Median: $107 (112% 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
Medica	$43 - $100	45%
Ucare	$52 - $104	55%
Dean Health Plan	$54	57%
Quartz	$55	58%
Aetna	$57 - $124	60%
Health Partners	$65 - $115	68%
Medical Associates	$91 - $98	96%
Midland Choice	$98	103%
Alliance	$102 - $109	107%
Claim Doc Llc	$104	109%
Group Health Of South Central	$104 - $130	109%
Wps Narrow Network	$105	110%
UnitedHealthcare	$106 - $130	111%
Cigna	$107	112%
Wps - Arise	$107	112%
Aspirus Arise Health	$108	113%
Allied National General	$110	116%
Preferred One	$110	116%
Wps Statewide	$110	116%
Blue Cross Blue Shield	$117 - $130	123%
Group Health Eau Claire	$117 - $130	123%
Coventry Health Care	$124	130%
Humana	$124	130%
Multiplan/Healtheos	$125	131%
Amerigroup	$130	137%
Icare	$130	137%
Iowa Total Care	$130	137%
Managed Health Service	$130	137%
Molina Health	$130	137%

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 $49.
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 Gundersen Lutheran 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.