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Wisconsin rates for HCPCS 99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $126 · 10th–90th $55–$3630%5%10th90th$126Professionalmedian $91 · 10th–90th $54–$2340%5%10%10th90th$91$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $147.91 / $346.74
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$63.10 / $251.19 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $87.10 / $234.42
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$56.23 / $95.50 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $194.98
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $117.49
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $107.15 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $281.84 / $457.09
Cigna
Facility/Professional
Facility
Modifier
22
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
Cigna
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
Cigna
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$10.23 / $10.23 / $10.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $138.04 / $263.03
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $72.44 / $141.25
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $234.42
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $75.86 / $169.82
Medica
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$50.12 / $147.91 / $416.87
Medica
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$151.36 / $186.21 / $186.21
Medica
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$23.99 / $29.51 / $29.51
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $194.98 / $416.87
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$131.83 / $177.83 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $87.10
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $114.82 / $190.55
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $147.91 / $239.88
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $630.96
Quartz
Facility/Professional
Facility
Modifier
22
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
Quartz
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$77.62 / $77.62 / $257.04
Quartz
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$12.30 / $12.30 / $41.69
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $123.03 / $562.34
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $107.15
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $186.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $63.10 / $74.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $162.18 / $223.87
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $95.50 / $138.04