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New York 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 $120 · 10th–90th $76–$3630%20%10th90th$120Professionalmedian $115 · 10th–90th $65–$2400%10%10th90th$115$1.0$10.0$100.0$1.0K$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
$75.86 / $120.23 / $234.42
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$6,456.54 / $6,456.54 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $114.82 / $239.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $74.13 / $138.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $1.07 / $208.93
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $125.89 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $141.25 / $346.74
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $93.33 / $245.47
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $138.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $89.13 / $154.88
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $120.23 / $199.53
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $141.25 / $194.98
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $83.18 / $218.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $75.86 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $114.82 / $204.17
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $79.43 / $234.42
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $208.93