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Maine 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 $224 · 10th–90th $107–$4370%20%10th90th$224Professionalmedian $105 · 10th–90th $63–$1740%10%20%10th90th$105$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$107.15 / $354.81 / $436.52
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $100.00 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $120.23 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $131.83 / $229.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $112.20 / $199.53
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $107.15 / $123.03
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $114.82 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $186.21