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Wisconsin rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $155 · 10th–90th $107–$2750%10%20%10th90th$155Professionalmedian $174 · 10th–90th $107–$5750%10%10th90th$174$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$107.15 / $141.25 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $165.96 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $223.87 / $446.68
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $194.98 / $269.15
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $346.74 / $436.52
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $281.84
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $346.74 / $407.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $281.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $323.59 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $95.50
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $363.08 / $660.69
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $331.13 / $478.63
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $1,000.00 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $812.83 / $1,000.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $467.74 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $380.19 / $537.03