CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Unitypoint Health - Meriter

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $84
Cash Discount Price: $191
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Unitypoint Health - Meriter is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.88x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $191 (201%)

Insurance Median: $84 (88%)

Cash: $191 (201% of Medicare)

Ins. Median: $84 (88% 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
Aspirus	$21 - $225	22%
Cigna	$26 - $180	27%
Security Health Plan	$28 - $192	29%
Mercy Care	$32 - $225	34%
Blue Cross Blue Shield	$61 - $609	64%
Illinicare	$61	64%
Prevea 360	$61 - $545	64%
UnitedHealthcare	$61 - $114	64%
Humana	$64	67%
Meridiancare	$64	67%
Health Partners Open Network	$84	88%
Medical Associates Health Plan	$131	138%
Wellmark Uph Self-Funded	$159	167%

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 $191.
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 Unitypoint Health - Meriter 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.