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New York 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 $200 · 10th–90th $126–$5,7540%20%10th90th$200$50.0$200.0$1.0K$5.0K$20.0K

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
$144.54 / $199.53 / $5,754.40
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $53,703.18
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $151.36 / $363.08
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $501.19 / $724.44
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $154.88 / $616.60