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New Mexico 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 $117 · 10th–90th $91–$1700%20%40%10th90th$117Professionalmedian $110 · 10th–90th $69–$2290%10%20%10th90th$110$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$91.20 / $117.49 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $109.65 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $81.28 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $114.82 / $186.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $190.55
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $120.23 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $134.90 / $173.78