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California 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 $100–$5750%20%10th90th$126Professionalmedian $123 · 10th–90th $72–$3390%10%20%10th90th$123$1.0$5.0$20.0$100.0$500.0$2.0K

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
$85.11 / $158.49 / $5,011.87
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$812.83 / $4,786.30 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $123.03 / $346.74
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $100.00 / $190.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $316.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $257.04
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $134.90 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $251.19
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $51.29 / $109.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $93.33 / $218.78
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $114.82 / $457.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $117.49 / $199.53
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $125.89 / $245.47
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $60.26 / $75.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $269.15