CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: North Central Health Care

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$86

about 0.9× the $95 Medicare rate · typically $72–$219

modeled estimate · not a bill or quote

Medicare pays $95 Fair price $86 Cash price $216 Hospital's list price $216

How we calculate the fair BaseRate →

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	$127 - $129	133%
Blue Cross Blue Shieldmajor	$127 - $129	133%
Aetnamajor	$129	136%
Cignamajor	$129	136%
Humanamajor	$129	136%
Medica	$129	136%
Molina	$129	136%
Security Health Plan	$141	148%
+ 9 smaller / regional plans	$129 - $138

Government programs also on file: Medicare, Medicaid.

Excludes 1 rental-network / third-party entry (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 216), 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 North Central Health Care 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 North Central Health Care

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

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