Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes
Medicare pricing data for 30,450 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 nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes (HCPCS code 99305) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $129.40, but hospitals typically charge $294.13 — a 2.3x 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 $129.40, your out-of-pocket cost would be approximately $25.88. 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 2.3x more than what Medicare allows for this procedure. Medicare actually pays $101.22 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $162 | $531 | 70 | 410 | +25.2% |
| New York | $140 | $408 | 2,139 | 147,407 | +8.0% |
| District of Columbia | $138 | $285 | 63 | 1,418 | +6.7% |
| California | $136 | $266 | 2,191 | 93,443 | +5.0% |
| New Jersey | $134 | $278 | 1,778 | 79,135 | +3.5% |
| Massachusetts | $133 | $276 | 653 | 24,364 | +2.9% |
| Connecticut | $133 | $286 | 430 | 14,619 | +2.8% |
| Maryland | $131 | $259 | 754 | 36,387 | +1.1% |
| Colorado | $131 | $253 | 353 | 5,305 | +1.0% |
| Rhode Island | $130 | $244 | 121 | 2,706 | +0.8% |
| Hawaii | $129 | $317 | 88 | 1,446 | -0.2% |
| Florida | $129 | $298 | 2,326 | 99,934 | -0.3% |
| Illinois | $129 | $258 | 1,606 | 70,143 | -0.5% |
| Montana | $129 | $286 | 131 | 913 | -0.6% |
| Wyoming | $128 | $322 | 104 | 884 | -1.4% |
| Washington | $127 | $315 | 356 | 9,963 | -1.7% |
| Maine | $127 | $259 | 154 | 1,926 | -2.1% |
| Michigan | $127 | $263 | 871 | 32,925 | -2.2% |
| Virginia | $126 | $283 | 618 | 20,032 | -2.3% |
| Puerto Rico | $126 | $146 | 16 | 99 | -2.7% |
| South Dakota | $126 | $309 | 148 | 671 | -2.8% |
| North Dakota | $126 | $343 | 162 | 1,260 | -2.9% |
| Pennsylvania | $125 | $277 | 1,854 | 45,626 | -3.3% |
| Delaware | $124 | $333 | 78 | 5,527 | -3.8% |
| Oregon | $124 | $289 | 189 | 2,611 | -4.0% |
| Wisconsin | $124 | $359 | 516 | 6,245 | -4.0% |
| Arizona | $124 | $300 | 332 | 8,007 | -4.1% |
| Nevada | $124 | $363 | 196 | 6,646 | -4.3% |
| Minnesota | $124 | $358 | 612 | 6,717 | -4.4% |
| Ohio | $124 | $239 | 1,417 | 34,293 | -4.4% |
| Texas | $123 | $301 | 2,002 | 47,605 | -4.8% |
| New Hampshire | $123 | $267 | 211 | 3,693 | -5.0% |
| Kentucky | $123 | $246 | 532 | 11,937 | -5.3% |
| Alabama | $123 | $227 | 353 | 8,938 | -5.3% |
| Louisiana | $122 | $264 | 413 | 6,639 | -5.7% |
| South Carolina | $122 | $232 | 311 | 8,926 | -5.7% |
| North Carolina | $122 | $268 | 728 | 21,235 | -5.7% |
| Georgia | $122 | $318 | 492 | 13,224 | -5.7% |
| West Virginia | $122 | $245 | 312 | 5,438 | -5.9% |
| Utah | $122 | $260 | 184 | 2,728 | -6.1% |
| Missouri | $121 | $240 | 701 | 16,062 | -6.1% |
| Tennessee | $121 | $253 | 521 | 16,644 | -6.4% |
| New Mexico | $120 | $250 | 86 | 2,106 | -6.9% |
| Iowa | $120 | $281 | 582 | 6,888 | -7.0% |
| Vermont | $120 | $285 | 87 | 1,078 | -7.1% |
| Indiana | $120 | $253 | 819 | 27,128 | -7.4% |
| Nebraska | $120 | $284 | 243 | 1,902 | -7.4% |
| Kansas | $120 | $308 | 421 | 7,510 | -7.7% |
| Idaho | $119 | $254 | 144 | 1,788 | -8.1% |
| Oklahoma | $119 | $239 | 410 | 12,072 | -8.4% |
| Mississippi | $119 | $253 | 280 | 5,310 | -8.4% |
| Arkansas | $117 | $231 | 279 | 5,182 | -9.2% |
⚠️ 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