CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HSHS St Clare Memorial Hospital

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$106

about 1.1× the $95 Medicare rate · typically $76–$245

modeled estimate · not a bill or quote

What this hospital charges insurers

$106

About the fair price

1.1× Medicare

Medicare pays $95 Fair price $106 This hospital $106 Cash price $157 Hospital's list price $238

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 $106

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 $106 (about 1.1× the $95 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $106, or about $157 in cash — about the fair price. Located in Oconto Falls, 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	$25 - $95	26%
Blue Cross Blue Shieldmajor	$25 - $154	26%
Aetnamajor	$25 - $369	26%
Cignamajor	$66 - $231	69%
Humanamajor	$25 - $314	26%
Health Net	$64 - $221	67%
Molina	$25 - $184	26%
Security Health Plan	$26 - $236	27%
+ 13 smaller / regional plans	$52 - $369

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 157), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm HSHS St Clare Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at HSHS St Clare Memorial Hospital

Compare: Office visit, established patient (20-29 min) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.