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Nationwide 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 $126 · 10th–90th $72–$8910%10%20%10th90th$126Professionalmedian $107 · 10th–90th $65–$2290%10%10th90th$107$1.0$10.0$100.0$1.0K$10.0K$100.0K

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
$64.57 / $109.65 / $977.24
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$81.28 / $537.03 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $107.15 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $316.23
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $104.71 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $257.04 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $128.82 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $81.28 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $112.20 / $234.42

See more rates by state

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