Commercial rate index · metro cell
Madison healthcare rate index
Commercial contracted rates in Madison, WI run 1.91x the national Medicare fee schedule across the office-visit basket. Index 199.1, where 100 is the national standard.
Index 199.1
1.91x Medicare
55,630 verified rate points
8/8 basket codes
state index 168.2
The basket in Madison
as of 2026-07-15| CPT | Service | Metro median | vs Medicare | Rate points | Tier |
|---|---|---|---|---|---|
| 99202 | Office visit, new patient, 15-29 min | $148.57 | 2.09x | 9,338 | Benchmark |
| 99203 | Office visit, new patient, 30-44 min | $219.06 | 1.99x | 5,689 | Benchmark |
| 99204 | Office visit, new patient, 45-59 min | $384.75 | 2.30x | 5,687 | Benchmark |
| 99205 | Office visit, new patient, 60-74 min | $516.12 | 2.35x | 10,589 | Benchmark |
| 99212 | Office visit, established patient, 10-19 min | $90.47 | 1.59x | 6,226 | Benchmark |
| 99213 | Office visit, established patient, 20-29 min | $127.78 | 1.38x | 5,454 | Benchmark |
| 99214 | Office visit, established patient, 30-39 min | $242.38 | 1.84x | 6,710 | Benchmark |
| 99215 | Office visit, established patient, 40-54 min | $276.56 | 1.49x | 5,937 | Benchmark |
Medians across the full verified distribution of practice-level contracted rates in this CBSA (31540). Floor: 11 verified rate points per code, non-degenerate spread. Denominator: CMS PFS CY2026 national non-facility. Methodology v1.0.
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
The market around it.
Madison prints above its state cell (Wisconsin at 168.2) and above the national standard of 100.
Cite this page
Source: Reddenda Commercial Rate Atlas, Madison, WI. Reddenda. https://reddenda.health/atlas/wi/madison-31540/
Derivation federally mandated TiC MRFs, verified to provider identityCBSA 31540 · metro grainas of 2026-07-15 · methodology v1.0