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Wisconsin rates for HCPCS 99226

Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.

Facilitymedian $302 · 10th–90th $234–$4790%20%10th90th$302Professionalmedian $263 · 10th–90th $79–$4790%10%10th90th$263$100.0$200.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $302.00 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $281.84 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $234.42 / $234.42
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $478.63 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $89.13 / $169.82