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Wisconsin rates for HCPCS 99223

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 high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Facilitymedian $245 · 10th–90th $126–$9770%10%20%10th90th$245Professionalmedian $200 · 10th–90th $132–$6030%20%10th90th$200$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
$112.20 / $316.23 / $977.24
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $190.55 / $588.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $275.42 / $512.86
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $245.47 / $338.84
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $524.81 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $436.52 / $575.44
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $199.53 / $346.74
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $426.58 / $512.86
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $204.17 / $436.52
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $436.52 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $263.03
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $398.11
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $380.19 / $645.65
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $371.54 / $549.54
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $1,202.26 / $1,202.26
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $977.24 / $1,202.26
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $501.19 / $776.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $229.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $467.74 / $645.65