CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence
A fair price for this
$110
about 1.2× the $95 Medicare rate · typically $67–$298
modeled estimate · not a bill or quote
What this hospital charges insurers
$117
About the fair price
about $7 over the fair price · 1.2× Medicare
Medicare pays $95 Fair price $110 This hospital $117 Cash price $68 Hospital's list price $117

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $60 Priciest $117

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $110 (about 1.2× the $95 Medicare rate). Gundersen St Josephs Hospital and Clinics charges insurers about $117, or about $68 in cash — about the fair price. Located in Hillsboro, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $62 - $82 65%
Blue Cross Blue Shieldmajor $62 - $117 65%
Aetnamajor $111 117%
Cignamajor $96 101%
Humanamajor $99 104%
Amerigroup $117 123%
Quartz $64 67%
Security Health Plan $23 24%
UCare $61 - $94 64%
+ 4 smaller / regional plans $93 - $117
Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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Facility Profile & Credentials

  • Address: 400 Water Ave, Hillsboro, WI 54634
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals