CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Upland Hills Health

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $162
Cash Discount Price: $192
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Upland Hills Health is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $192. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.70x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$192

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $192 (202%)

Insurance Median: $162 (170%)

Cash: $192 (202% of Medicare)

Ins. Median: $162 (170% 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
Humana	$60 - $399	63%
Blue Cross Blue Shield	$67 - $363	70%
Icare	$67 - $124	70%
Medical Associates	$67 - $332	70%
Mhs	$67 - $124	70%
Security Health Plan	$67 - $124	70%
UnitedHealthcare	$85	89%
Alliance	$86 - $251	90%
Dean Health Plan	$116 - $308	122%
Wps	$145 - $279	152%
Ghc Of Sc Wi	$162 - $301	170%
Quartz	$164 - $306	172%
Cigna	$177 - $370	186%
Multiplan	$209 - $390	220%

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 $192.
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 Upland Hills Health 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.