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Virginia 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 $100 · 10th–90th $66–$2190%10%10th90th$100Professionalmedian $100 · 10th–90th $65–$1740%10%10th90th$100$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 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $131.83 / $199.53
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $91.20 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $114.82 / $218.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $93.33 / $331.13
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $117.49 / $147.91
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $128.82 / $181.97
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $478.63
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $102.33 / $204.17