Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes
Medicare pricing data for 290,012 providers across 52 states
This is one of the most commonly performed procedures in Medicare, with 6.1 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes (HCPCS code 99222) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $127.64, but hospitals typically charge $365.21 — a 2.9x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $127.64, your out-of-pocket cost would be approximately $25.53. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.9x more than what Medicare allows for this procedure. Medicare actually pays $99.68 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $167 | $650 | 524 | 6,118 | +31.0% |
| New York | $142 | $475 | 19,473 | 455,086 | +11.0% |
| District of Columbia | $137 | $366 | 1,034 | 16,403 | +7.6% |
| New Jersey | $136 | $400 | 9,002 | 291,552 | +6.2% |
| California | $135 | $403 | 21,382 | 396,948 | +5.8% |
| Connecticut | $133 | $369 | 4,402 | 79,631 | +4.3% |
| Maryland | $132 | $361 | 5,507 | 117,498 | +3.1% |
| Illinois | $131 | $361 | 12,525 | 321,047 | +2.8% |
| Massachusetts | $131 | $417 | 9,268 | 171,436 | +2.5% |
| Florida | $130 | $372 | 19,351 | 571,852 | +1.6% |
| Rhode Island | $129 | $338 | 1,185 | 18,427 | +0.9% |
| Hawaii | $129 | $330 | 723 | 8,292 | +0.7% |
| Michigan | $128 | $287 | 11,067 | 262,136 | +0.6% |
| Washington | $128 | $386 | 5,942 | 66,985 | +0.2% |
| Puerto Rico | $127 | $228 | 691 | 5,596 | -0.3% |
| Virginia | $127 | $334 | 7,199 | 153,460 | -0.7% |
| Pennsylvania | $127 | $319 | 17,509 | 374,629 | -0.8% |
| Nevada | $127 | $396 | 1,768 | 51,555 | -0.8% |
| Montana | $127 | $357 | 1,060 | 15,563 | -0.9% |
| Delaware | $126 | $340 | 1,129 | 36,435 | -1.2% |
| Colorado | $126 | $367 | 4,409 | 42,952 | -1.6% |
| New Hampshire | $125 | $462 | 1,793 | 29,081 | -1.9% |
| Oregon | $125 | $389 | 3,412 | 32,733 | -2.0% |
| Texas | $125 | $353 | 18,323 | 434,154 | -2.4% |
| Wyoming | $124 | $427 | 376 | 7,161 | -2.5% |
| Arizona | $124 | $363 | 5,069 | 104,294 | -2.7% |
| New Mexico | $124 | $377 | 1,469 | 19,563 | -3.2% |
| Missouri | $124 | $318 | 6,713 | 150,605 | -3.2% |
| Louisiana | $123 | $299 | 3,733 | 77,070 | -3.6% |
| Vermont | $123 | $411 | 631 | 8,934 | -3.6% |
| Maine | $123 | $354 | 1,680 | 18,884 | -3.7% |
| Georgia | $123 | $362 | 8,379 | 144,943 | -3.8% |
| North Dakota | $123 | $396 | 1,009 | 19,822 | -3.9% |
| Ohio | $123 | $356 | 12,945 | 268,324 | -4.0% |
| West Virginia | $122 | $316 | 2,126 | 55,408 | -4.2% |
| Utah | $122 | $293 | 1,915 | 24,945 | -4.7% |
| Minnesota | $121 | $490 | 6,732 | 80,864 | -5.0% |
| Oklahoma | $121 | $310 | 2,710 | 61,612 | -5.0% |
| North Carolina | $121 | $384 | 9,377 | 139,330 | -5.1% |
| South Carolina | $121 | $323 | 4,399 | 91,697 | -5.2% |
| Kentucky | $121 | $295 | 4,468 | 108,179 | -5.3% |
| South Dakota | $121 | $323 | 1,138 | 19,572 | -5.5% |
| Alabama | $120 | $263 | 3,899 | 80,581 | -5.8% |
| Wisconsin | $120 | $503 | 6,228 | 89,592 | -6.0% |
| Idaho | $119 | $332 | 1,298 | 16,280 | -6.4% |
| Indiana | $119 | $283 | 6,378 | 137,544 | -6.6% |
| Mississippi | $119 | $282 | 2,016 | 51,008 | -7.0% |
| Iowa | $118 | $359 | 2,955 | 58,231 | -7.3% |
| Tennessee | $118 | $362 | 6,251 | 125,378 | -7.5% |
| Kansas | $118 | $329 | 2,774 | 60,732 | -7.6% |
| Arkansas | $118 | $258 | 2,180 | 58,577 | -7.8% |
| Nebraska | $118 | $331 | 2,348 | 38,859 | -7.8% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
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