UnitedHealthcare negotiated rates in Wisconsin
How UnitedHealthcare's Wisconsin rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
UnitedHealthcare in Wisconsin at a glance
What the data shows
UnitedHealthcare ranks 1st of 4 payers in Wisconsin with a rate index of 125 (100 = the Wisconsin market median), across 228 procedure codes.
UnitedHealthcare has the highest median for 57% of codes in Wisconsin.
UnitedHealthcare's Wisconsin rates sit 73% above its own national level, the 2nd highest of its 51 states.
Largest premium over the Wisconsin market: CPT 67840 (Remove eyelid lesion) at 198% of market; largest discount: CPT 88305 (Tissue exam by pathologist) at 75%.
How the four payers compare in Wisconsin
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 125 | 1 | 57% | 610 | |
| Blue Cross Blue Shield | 114 | 2 | 42% | 733 | |
| Cigna | 67 | 3 | 1% | 296 | |
| Aetna | 51 | 4 | 0% | 291 |
Where UnitedHealthcare pays most and least against the Wisconsin market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 67840 Remove eyelid lesion | $757 | $383 | +98% | 67 |
| 37243 Vasc embolize/occlude organ | $2,036 | $1,121 | +82% | 76 |
| 93656 Compre ep eval abltj atr fib | $3,859 | $2,134 | +81% | 74 |
| 65778 Cover eye w/membrane | $156 | $87 | +80% | 62 |
| 51720 Treatment of bladder lesion | $289 | $167 | +73% | 87 |
| 68761 Close tear duct opening | $481 | $282 | +71% | 69 |
| 67108 Repair detached retina | $3,956 | $2,323 | +70% | 69 |
| 66991 Xcapsl ctrc rmvl insj 1+ | $2,282 | $1,341 | +70% | 69 |
Furthest below market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 88305 Tissue exam by pathologist | $69 | $91 | -25% | 143 |
| 88312 Special stains group 1 | $102 | $129 | -21% | 143 |
| 88313 Special stains group 2 | $73 | $92 | -20% | 71 |
| 88342 Imhchem/imcytchm 1st antb | $103 | $128 | -20% | 72 |
| 93298 Rem interrog dev eval scrms | $70 | $84 | -17% | 74 |
| 93297 Rem interrog dev eval icpms | $69 | $78 | -12% | 74 |
| 92242 Fluorescein&icg angiography | $454 | $511 | -11% | 69 |
| 92235 Fluorescein angrph mltiframe | $199 | $223 | -11% | 69 |
Where UnitedHealthcare pays above and below its national level
Frequently asked questions
Does UnitedHealthcare pay more or less than the other payers in Wisconsin?
UnitedHealthcare ranks 1st of 4 in Wisconsin with an index of 125. It is highest on 57% of codes.
Are UnitedHealthcare's Wisconsin rates above or below its national level?
About 73% above.
Which procedure does UnitedHealthcare pay most above market in Wisconsin?
CPT 67840 (Remove eyelid lesion), at 198% of the Wisconsin median.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Is your UnitedHealthcare contract at market in Wisconsin?
Compare your negotiated rates for these codes with Wisconsin medians for each payer.