Initial Hospital Or Observation Visit, Lower Complexity
West Virginia rates for HCPCS 99221
The first evaluation by a doctor or other qualified clinician after a person is admitted to hospital as an inpatient or placed under observation care, at the level used for more straightforward cases. It covers taking the history, examining the patient, reviewing results and setting out the initial plan of care for that day.
Rates data updated October 2026.
How much does Initial Hospital Or Observation Visit, Lower Complexity cost?
$105
Typical physician fee. In West Virginia, October 2026.
Insurers have agreed to pay about $105 for this service. Most negotiated rates run $83.18 to $145.
These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.
How much rates vary
Facilitymedian $83 · 10th to 90th $83 to $105Professionalmedian $107 · 10th to 90th $79 to $224
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$93.33
Facility
None
$83.18
$83.18
$93.33
Aetna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$107.15
Typical High
$144.54
Professional
None
$83.18
$107.15
$144.54
CareSource
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$93.33
Typical High
$128.82
Professional
None
$77.62
$93.33
$128.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Facility
None
$104.71
$104.71
$104.71
Cigna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$181.97
Typical High
$363.08
Professional
None
$83.18
$181.97
$363.08
Highmark BCBS
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Professional
None
$95.50
$95.50
$95.50
United
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$93.33
Typical High
$208.93
Professional
None
$66.07
$93.33
$208.93
3 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$38.90
Median
$41.69
Typical High
$41.69
Professional
52 · Reduced service
$38.90
$41.69
$41.69
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$11.75
Median
$12.59
Typical High
$12.59
Professional
55 · Aftercare only
$11.75
$12.59
$12.59
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.94
Median
$8.32
Typical High
$8.32
Professional
56 · Pre-op care only
$7.94
$8.32
$8.32
Where West Virginia sits
The same service costs 2.3 times more in Alaska than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.