CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Bellin Health Oconto Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $300
Cash Discount Price: $260
vs. Medicare Baseline: 3.15x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Bellin Health Oconto Hospital is $300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.15x the Medicare baseline. Located in 820 Arbutus Ave, Oconto, WI.

Cash / Self-Pay

$260

Average discount available for prompt cash payment at this facility.

Insurance Median

$300

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: $260 (273%)

Insurance Median: $300 (315%)

Cash: $260 (273% of Medicare)

Ins. Median: $300 (315% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 315% of the Medicare baseline (a markup of 215%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$136 - $309	143%
Community Care	$136	143%
Humana	$136	143%
My Choice	$136	143%
Network Health	$136 - $340	143%
UnitedHealthcare	$164 - $280	172%
Aetna	$200	210%
Cigna	$283 - $288	297%
Common Ground	$291 - $299	306%
Chorus Community Health Plan	$300	315%
Aspirus Arise	$313	329%
Healthsmart	$320	336%
Ihs(Claimsbridge)	$320	336%
Medical College Of Wi	$320	336%
Hps/Paymedix	$328 - $356	345%
Wps Insurance	$336	353%
Allied National	$340	357%
First Health	$340	357%
Galaxy Health	$340	357%
Three Rivers Provider Network	$360	378%
Trilogy	$360	378%

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 $260.
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 Bellin Health Oconto Hospital 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.