Office visit, established patient (20-29 min)
Facility: Childrens Hospital of Wisconsin Fox Valley
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $310
- Cash Discount Price: $213
- vs. Medicare Baseline: 3.26x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 326% of the Medicare baseline (a markup of 226%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $60 - $151 | 63% |
| Chorus Community Health Plan | $64 | 67% |
| Managed Health Services | $65 | 68% |
| Molina Healthcare Of Wisconsin | $65 | 68% |
| Blue Cross Blue Shield | $66 - $171 | 69% |
| Icare | $66 | 69% |
| My Choice Wisconsin | $66 | 69% |
| Multiplan | $83 - $352 | 87% |
| Aetna | $103 - $348 | 108% |
| Employer Health Care Alliance Cooperative | $183 | 192% |
| Network Health Plan | $266 | 279% |
| Medical College Of Wisconsin | $271 | 285% |
| Wps Health Plan | $271 | 285% |
| Aspirus Health Plan | $279 | 293% |
| Common Ground Healthcare Cooperative | $279 | 293% |
| Centivo | $283 | 297% |
| Advocate Aurora Healthcare | $290 | 305% |
| Health Partners | $302 - $341 | 317% |
| Dean Health Plan | $310 | 326% |
| Froedtert Health | $310 - $348 | 326% |
| Oan Llc | $310 | 326% |
| Trilogy Health Solutions | $310 | 326% |
| Security Health Plan | $321 | 337% |
| Health Payment Systems | $327 | 344% |
| Quartz Health Solutions | $329 | 346% |
| Sheboygan Employer'S Health Network | $329 | 346% |
| America'S Ppo | $337 | 354% |
| Cigna | $348 | 366% |
| Group Health Cooperative Of South Central Wisconsin | $348 | 366% |
| Healthsmart Payers Organization | $348 | 366% |
| Coventry Health Care | $368 | 387% |
| Health Payers Organization | $368 | 387% |