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Wisconsin rates for HCPCS 99235

Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.

Facilitymedian $174 · 10th–90th $105–$4790%10%10th90th$174Professionalmedian $372 · 10th–90th $224–$4900%20%10th90th$372$100.0$200.0$500.0$1.0K

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
$102.33 / $134.90 / $288.40
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $223.87 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $478.63 / $776.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $316.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $316.23
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $331.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $371.54 / $489.78
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,023.29 / $1,023.29
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $128.82 / $134.90