CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $132
Cash Discount Price: $126
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at University of Wi Hospitals & Clinics Authority is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.39x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $126 (132%)

Insurance Median: $132 (139%)

Cash: $126 (132% of Medicare)

Ins. Median: $132 (139% 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
Medicare (plans)	$63 - $147	66%
Alliance_Premier_Network	$100	105%
Mercycare	$104	109%
Triology	$107 - $128	112%
Security_Health_Plan	$113 - $133	119%
Employer'S_Coalition_On_Health	$116 - $162	122%
Alliance	$118	124%
Blue Cross Blue Shield	$119 - $200	125%
Hfn	$120 - $162	126%
United_Healthcare	$120 - $178	126%
Beloit_Health_System	$122	128%
Aspirus_Health_Plan	$123	129%
Cigna	$126	132%
Health_Partners_Insurance	$128	134%
Health_Payment_Systems	$129	136%
UnitedHealthcare	$131	138%
Dean_Health_Plan	$134	141%
Medical_Associates	$139	146%
Wps	$146 - $160	153%
Employers_Healthcare_Coalition_Of_Wi	$147	154%
Aetna	$150 - $168	158%
Aspirus_Network_Inc	$162	170%
Chorus_Community	$168	176%
Ghc_Eau_Claire_Health_Plan	$168	176%
Multiplan	$168 - $193	176%
Sheybogan_Employers_Health_Network	$168	176%
Coventry	$178	187%
Dean_Care	$178	187%
Healthsmart	$185	194%

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 $126.
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 University of Wi Hospitals & Clinics Authority 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.