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Wisconsin rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $224 · 10th–90th $166–$4170%20%10th90th$224Professionalmedian $204 · 10th–90th $138–$5370%20%10th90th$204$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
$158.49 / $218.78 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $190.55 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $257.04 / $512.86
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $316.23
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $251.19 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $331.13 / $602.56
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $389.05
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $436.52 / $562.34
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $223.87 / $426.58
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $407.38 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $64.57 / $288.40
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $416.87 / $645.65
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $426.58 / $630.96
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $1,148.15
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $407.38 / $1,348.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $407.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $501.19 / $707.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $169.82 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $457.09 / $691.83