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99235

Initial hospital care with same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes

Medicare pricing data for 26,238 providers across 52 states

🤖AI Overview

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 same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes (HCPCS code 99235) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $155.06, but hospitals typically charge $474.56 — a 3.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$31.01

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $155.06, your out-of-pocket cost would be approximately $31.01. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$155.06
Average Hospital Charge
$474.56
Markup Ratio
3.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$474.56
Medicare Allowed$155.06
Medicare Payment$118.22

Hospitals charge 3.1x more than what Medicare allows for this procedure. Medicare actually pays $118.22 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$205$8675876+32.1%
District of Columbia$167$46588164+7.8%
California$167$5511,6273,908+7.7%
New York$165$5791,6754,493+6.5%
Connecticut$162$4465031,326+4.4%
Massachusetts$162$5469912,412+4.4%
New Jersey$161$5761,0113,096+3.6%
Rhode Island$159$553154298+2.7%
Maryland$159$4884511,117+2.6%
Illinois$159$4551,1853,137+2.4%
Florida$158$4621,9166,099+1.7%
Nevada$156$616193480+0.5%
Washington$156$498403771+0.4%
Puerto Rico$155$21139128+0.1%
Michigan$155$4291,0252,531-0.2%
Hawaii$155$4404692-0.3%
Colorado$154$463260464-0.4%
Wyoming$154$46859113-0.9%
Oregon$153$490241472-1.1%
Pennsylvania$153$4081,5683,835-1.2%
New Hampshire$153$583163391-1.3%
Vermont$153$52663126-1.4%
Virginia$153$4666491,871-1.6%
Montana$152$443105191-1.7%
Arizona$152$5114201,206-1.8%
New Mexico$152$528123224-1.9%
Texas$152$4511,6964,278-2.0%
Minnesota$152$573465761-2.2%
Maine$151$461129207-2.3%
Missouri$151$4045741,190-2.7%
North Dakota$150$495136245-3.0%
Ohio$150$3971,1012,875-3.2%
Delaware$150$434156520-3.4%
South Dakota$149$422102161-3.7%
West Virginia$149$393235590-3.7%
Wisconsin$149$664494842-3.9%
Louisiana$149$418311759-3.9%
Kentucky$149$3695041,271-4.0%
Oklahoma$149$403264600-4.0%
Georgia$149$4877111,521-4.0%
Utah$148$382202470-4.3%
North Carolina$148$5088721,575-4.9%
South Carolina$147$447401760-5.0%
Alabama$147$375330889-5.3%
Idaho$147$42588147-5.4%
Kansas$146$499281522-5.6%
Iowa$146$493255416-5.8%
Tennessee$146$483445860-5.8%
Indiana$146$3786681,747-6.1%
Mississippi$145$396219584-6.5%
Arkansas$145$325293864-6.6%
Nebraska$144$405206372-7.3%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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Related Procedures

99214Established patient office or other outpatient visit, 30-39 minutes
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99213Established patient office or other outpatient visit, 20-29 minutes
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99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
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99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
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99204New patient office or other outpatient visit, 45-59 minutes
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