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Wisconsin rates for HCPCS 99243

Office or other outpatient consultation for a new or 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, 30 minutes must be met or exceeded.

Facilitymedian $123 · 10th–90th $83–$2140%10%10th90th$123Professionalmedian $115 · 10th–90th $72–$2950%5%10%10th90th$115$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
$77.62 / $131.83 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $104.71 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $128.82 / $257.04
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $154.88
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $134.90 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $173.78 / $323.59
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $117.49 / $208.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $302.00
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $123.03 / $229.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $234.42 / $741.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $69.18 / $131.83
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $223.87 / $398.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $331.13
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $588.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $208.93 / $741.31
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $218.78
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $269.15 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $263.03 / $398.11