Commercial healthcare reimbursement in Wisconsin
How Wisconsin compares with the nation, by payer, specialty and procedure.
Wisconsin at a glance
What the data shows
Wisconsin ranks 2nd of 51 states for commercial reimbursement, with an index of 159 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Wisconsin run a median 225% of Medicare.
UnitedHealthcare has the highest index in the state (125) and Aetna the lowest (51), a 74-point gap, in the files analyzed.
CPT 14061 (Tis trnfr e/n/e/l10.1-30sqcm) is the strongest relative to the national median (229% of it, a 129% premium); CPT 97110 (Therapeutic exercises) has the smallest premium (118% of the national median).
Wisconsin ranks consistently across specialties: between 2nd and 4th of 50 states across the 8 specialties tracked.
Against Medicare, gastroenterology has the highest ratio in Wisconsin (372% of Medicare) and ophthalmology the lowest (199%).
Payer ranking in Wisconsin
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 125 | 1 | 228 | 610 | 323 | |
| Blue Cross Blue Shield | 114 | 2 | 228 | 733 | 557 | |
| Cigna | 67 | 3 | 227 | 296 | 232 | |
| Aetna | 51 | 4 | 225 | 291 | 290 |
Reimbursement index by specialty in Wisconsin
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Urology | 166 | 2 of 50 | 269% | 37 | 114 | |
| Orthopedic surgery | 150 | 2 of 51 | 210% | 39 | 100 | |
| Cardiology | 145 | 2 of 51 | 212% | 38 | 108 | |
| Internal medicine | 172 | 2 of 51 | 220% | 25 | 106 | |
| Dermatology | 204 | 2 of 50 | 201% | 44 | 104 | |
| Diagnostic radiology | 137 | 3 of 51 | 215% | 49 | 123 | |
| Gastroenterology | 179 | 3 of 50 | 372% | 36 | 110 | |
| Ophthalmology | 164 | 4 of 50 | 199% | 42 | 104 |
Specialty by payer in Wisconsin
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 204 | 64 | 91 | 169 |
| Dermatology | 233 | 74 | 137 | 224 |
| Ophthalmology | 206 | 83 | 144 | 215 |
| Cardiology | 180 | 77 | 96 | 154 |
| Orthopedic surgery | 176 | 74 | 119 | 231 |
| Diagnostic radiology | 185 | 106 | 94 | 153 |
| Urology | 198 | 61 | 101 | 188 |
| Gastroenterology | 210 | 91 | 99 | 194 |
Wisconsin compared with Midwest region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Wisconsin | 159 | 2 | 225% | 869 | |
| Nebraska | 138 | 4 | 198% | 601 | |
| South Dakota | 135 | 6 | 202% | 474 | |
| Iowa | 128 | 8 | 195% | 716 | |
| North Dakota | 127 | 9 | 197% | 369 | |
| Minnesota | 126 | 10 | 167% | 853 |
Procedures that pay most and least in Wisconsin vs the nation
Highest vs national
| Code | Wisconsin | National | Gap | Prov. |
|---|---|---|---|---|
| 14061 Tis trnfr e/n/e/l10.1-30sqcm | $2,460 | $1,074 | +129% | 103 |
| 17004 Destroy premal lesions 15/> | $343 | $154 | +123% | 103 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $426 | $195 | +118% | 103 |
| 13101 Cmplx rpr trunk 2.6-7.5 cm | $812 | $374 | +117% | 103 |
| 43238 Egd us fine needle bx/aspir | $831 | $383 | +117% | 106 |
| 17311 Mohs 1 stage h/n/hf/g | $1,243 | $577 | +115% | 103 |
| 11603 Exc tr-ext mal+marg 2.1-3 cm | $571 | $267 | +114% | 103 |
| 43237 Endoscopic us exam esoph | $677 | $318 | +113% | 106 |
| 13121 Cmplx rpr s/a/l 2.6-7.5 cm | $844 | $398 | +112% | 103 |
| 17262 Dstrj mal les t/a/l 1.1-2.0 | $345 | $163 | +112% | 103 |
| 14060 Tis trnfr e/n/e/l 10 sq cm/< | $1,764 | $835 | +111% | 103 |
| 43246 Egd place gastrostomy tube | $714 | $338 | +111% | 106 |
| 11602 Exc tr-ext mal+marg 1.1-2 cm | $481 | $228 | +111% | 103 |
| 12052 Intmd rpr face/mm 2.6-5.0 cm | $609 | $289 | +110% | 103 |
| 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm | $1,042 | $498 | +109% | 103 |
Lowest vs national
| Code | Wisconsin | National | Gap | Prov. |
|---|---|---|---|---|
| 97110 Therapeutic exercises | $37 | $31 | +18% | 100 |
| 93971 Extremity study | $205 | $172 | +19% | 123 |
| 65778 Cover eye w/membrane | $87 | $70 | +24% | 82 |
| 70551 Mri brain stem w/o dye | $501 | $402 | +25% | 118 |
| 72125 Ct neck spine w/o dye | $310 | $249 | +25% | 114 |
| 71250 Ct thorax dx c- | $314 | $250 | +25% | 114 |
| 73221 Mri joint upr extrem w/o dye | $500 | $399 | +26% | 210 |
| 72148 Mri lumbar spine w/o dye | $481 | $382 | +26% | 210 |
| 72131 Ct lumbar spine w/o dye | $312 | $248 | +26% | 114 |
| 73721 Mri jnt of lwr extre w/o dye | $504 | $399 | +26% | 210 |
| 77280 Ther rad simulaj field smpl | $386 | $302 | +28% | 99 |
| 72197 Mri pelvis w/o & w/dye | $818 | $634 | +29% | 118 |
| 74183 Mri abd w/o cntr flwd cntr | $821 | $634 | +29% | 118 |
| 72141 Mri neck spine w/o dye | $505 | $390 | +30% | 118 |
| 72158 Mri lumbar spine w/o & w/dye | $773 | $593 | +30% | 118 |
Frequently asked questions
How do commercial reimbursement rates in Wisconsin compare with the rest of the country?
Wisconsin ranks 2nd of 51 states with an index of 159, across 228 procedure codes. Median commercial rates run 225% of the Medicare rate.
Which payer has the highest rates in Wisconsin?
In the files we analyzed, UnitedHealthcare has the highest index (125) and Aetna the lowest (51). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Wisconsin?
Urology ranks 2nd of 50 states.
How many providers does this Wisconsin page cover?
869 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Wisconsin and the national median?
CPT 14061 (Tis trnfr e/n/e/l10.1-30sqcm) is highest relative to the nation at 229% of the national median; CPT 97110 (Therapeutic exercises) is lowest at 118%.
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.
Benchmark your Wisconsin contracts
Compare your negotiated rates with these state medians by payer and specialty.