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Wisconsin rates for HCPCS 99221

Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Facilitymedian $100 · 10th–90th $59–$2820%10%10th90th$100Professionalmedian $112 · 10th–90th $62–$3020%5%10%10th90th$112$1.0$5.0$20.0$100.0$500.0

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
$52.48 / $70.79 / $151.36
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $107.15 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $131.83 / $251.19
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $114.82 / $162.18
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $245.47 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $204.17 / $263.03
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $95.50 / $169.82
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $199.53 / $239.88
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $95.50 / $165.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $190.55 / $616.60
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $131.83
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $199.53
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $190.55 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $263.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $616.60 / $616.60
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $489.78 / $616.60
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $40.74 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $234.42 / $323.59