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Missouri 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 $89 · 10th–90th $49–$1660%10%10th90th$89Professionalmedian $105 · 10th–90th $62–$1860%10%10th90th$105$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $83.18 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $104.71 / $186.21
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $97.72 / $158.49
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $85.11 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $117.49 / $204.17
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $107.15 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $114.82 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $79.43 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $154.88