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North Carolina rates for HCPCS 99235

Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.

Facilitymedian $234 · 10th–90th $162–$4680%20%10th90th$234Professionalmedian $219 · 10th–90th $219–$2190%50%100%$219$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $234.42 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $229.09 / $363.08
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29