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North Carolina 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 $145 · 10th–90th $76–$3240%10%10th90th$145Professionalmedian $112 · 10th–90th $66–$2400%5%10%10th90th$112$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
$97.72 / $144.54 / $281.84
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$70.79 / $208.93 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $104.71 / $245.47
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $173.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $154.88 / $229.09
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
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $134.90 / $199.53
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $251.19
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,570.88 / $4,570.88 / $8,709.64
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $33.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $104.71 / $194.98
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60