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New York rates for HCPCS 99223

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 high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Facilitymedian $229 · 10th–90th $151–$3630%20%40%10th90th$229Professionalmedian $200 · 10th–90th $126–$4790%20%10th90th$200$0.1$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
$158.49 / $229.09 / $363.08
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$295.12 / $295.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $158.49 / $245.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $147.91 / $416.87
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $275.42 / $691.83
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $177.83 / $398.11
Emblem Health
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$0.10 / $0.10 / $0.10
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $177.83 / $288.40
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $190.55 / $323.59
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $257.04 / $457.09
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $281.84 / $380.19
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $173.78 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $158.49 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $229.09 / $389.05
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $165.96 / $537.03
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $194.98 / $446.68