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New Jersey 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 $135 · 10th–90th $59–$6,9180%10%10th90th$135Professionalmedian $107 · 10th–90th $63–$2000%5%10%10th90th$107$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
$58.88 / $77.62 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $100.00 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $138.04
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $5,128.61 / $7,413.10
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $128.82 / $218.78
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $77.62 / $125.89
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $66.07 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $100.00 / $194.98