Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes
Medicare pricing data for 31,877 providers across 52 states
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 high level of medical decision making, per day, if using time, at least 85 minutes (HCPCS code 99236) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $203.93, but hospitals typically charge $768.18 — a 3.8x 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 $203.93, your out-of-pocket cost would be approximately $40.79. 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 3.8x more than what Medicare allows for this procedure. Medicare actually pays $157.08 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $274 | $1,391 | 69 | 150 | +34.2% |
| New York | $218 | $894 | 1,903 | 6,092 | +7.1% |
| District of Columbia | $217 | $690 | 128 | 404 | +6.5% |
| California | $216 | $880 | 2,788 | 8,026 | +6.0% |
| Massachusetts | $213 | $758 | 1,448 | 4,352 | +4.7% |
| New Jersey | $212 | $1,011 | 1,107 | 4,299 | +3.9% |
| Connecticut | $209 | $683 | 454 | 1,395 | +2.7% |
| Illinois | $209 | $638 | 1,342 | 5,047 | +2.6% |
| Rhode Island | $209 | $1,462 | 244 | 884 | +2.6% |
| Nevada | $207 | $697 | 311 | 1,568 | +1.3% |
| Florida | $206 | $709 | 2,320 | 8,889 | +0.8% |
| Washington | $205 | $1,033 | 663 | 1,413 | +0.4% |
| Maryland | $204 | $937 | 713 | 2,497 | -0.2% |
| Puerto Rico | $203 | $287 | 22 | 53 | -0.4% |
| Michigan | $203 | $870 | 1,162 | 3,853 | -0.5% |
| Maine | $202 | $688 | 148 | 306 | -1.0% |
| Virginia | $202 | $717 | 838 | 2,175 | -1.1% |
| Montana | $201 | $592 | 102 | 212 | -1.4% |
| Pennsylvania | $201 | $622 | 1,558 | 4,122 | -1.5% |
| Oregon | $201 | $798 | 358 | 759 | -1.6% |
| New Mexico | $201 | $857 | 118 | 283 | -1.6% |
| Colorado | $201 | $873 | 572 | 1,217 | -1.7% |
| North Dakota | $200 | $668 | 98 | 214 | -1.9% |
| Wyoming | $200 | $657 | 49 | 86 | -2.1% |
| Ohio | $199 | $557 | 1,242 | 3,842 | -2.3% |
| Delaware | $199 | $663 | 136 | 402 | -2.5% |
| Arizona | $199 | $745 | 574 | 1,954 | -2.7% |
| Vermont | $198 | $613 | 65 | 118 | -2.9% |
| South Dakota | $198 | $508 | 84 | 183 | -2.9% |
| Texas | $198 | $670 | 2,062 | 6,665 | -3.0% |
| Louisiana | $197 | $633 | 404 | 1,190 | -3.3% |
| Wisconsin | $197 | $928 | 448 | 959 | -3.6% |
| New Hampshire | $196 | $963 | 187 | 523 | -3.7% |
| Minnesota | $196 | $883 | 581 | 1,001 | -3.8% |
| Idaho | $196 | $755 | 126 | 226 | -3.8% |
| Oklahoma | $196 | $802 | 350 | 912 | -3.9% |
| Missouri | $195 | $597 | 531 | 1,340 | -4.3% |
| Georgia | $194 | $896 | 967 | 2,682 | -4.7% |
| Hawaii | $194 | $688 | 95 | 153 | -4.8% |
| South Carolina | $194 | $734 | 493 | 1,326 | -4.9% |
| Utah | $194 | $911 | 233 | 361 | -4.9% |
| Kentucky | $194 | $655 | 469 | 1,412 | -5.0% |
| North Carolina | $193 | $754 | 1,229 | 2,599 | -5.1% |
| Mississippi | $193 | $766 | 262 | 726 | -5.6% |
| West Virginia | $192 | $782 | 163 | 372 | -5.8% |
| Kansas | $192 | $725 | 286 | 614 | -5.8% |
| Arkansas | $192 | $558 | 217 | 623 | -5.9% |
| Tennessee | $191 | $678 | 618 | 1,512 | -6.2% |
| Alabama | $191 | $627 | 373 | 1,135 | -6.6% |
| Iowa | $190 | $652 | 208 | 400 | -6.6% |
| Indiana | $190 | $541 | 670 | 1,734 | -6.9% |
| Nebraska | $189 | $539 | 210 | 454 | -7.4% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber