go back

Observation Care Admission, Moderate Complexity

Wisconsin rates for HCPCS 99219

The doctor's first full assessment when you are placed under observation in hospital for monitoring and testing. It covers a more detailed history and examination and a moderately involved plan, for a problem that is more complicated than a routine one but not immediately dangerous.

Rates data updated July 2026.

How much does Observation Care Admission, Moderate Complexity cost?

$389

Typical physician fee. In Wisconsin, July 2026.

Insurers have agreed to pay about $389 for this service. Most negotiated rates run $282 to $513.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $389 · 10th to 90th $331 to $617Professionalmedian $372 · 10th to 90th $85 to $631
$100$200$500facility $389professional $372

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$389.05
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$371.54
Typical High
$416.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Quartz
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$467.74
Typical High
$467.74
Quartz
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$630.96
Typical High
$630.96
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$245.47

Where Wisconsin sits

The same service costs 20.9 times more in Massachusetts than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wisconsin· 10th of 50

$389

MA $631SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.