Hospitalist reimbursement rates by service line
Compare national hospitalist reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 99223, 99232 and 99233 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
Rate Explorer
Compare national hospitalist rates by payer
Compare national payer rates for common inpatient encounters and see how reimbursement changes across the hospital stay.
Aetna state variation for 99233
National 99233 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 99233 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 57,313 | $113.09 | $130.80 | |||
| Cigna | Jun–Jul 2026 | 67,380 | $163.88 | $181.45 | |||
| United | Jun–Jul 2026 | 62,353 | $168.55 | $183.90 | |||
| Anthem | Jun–Jul 2026 | 69,501 | $191.33 | $197.15 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for subsequent hospital care, high level (99233).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
Confirm coverage for your codes, payers and markets.
How do specific hospitalist providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Hospitalist provider rates by payer (CPT 99233)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| COMMUNITY PHYSICIANS OF INDIANA INCNPI 1013175827 · Tax ID 205392766 | IN | 2,994 | $74.46 | -$38.63 | Below P25 |
| BKAYALI LLCNPI 1659620532 · Tax ID 465401035 | KS | 2 | $86.98 | -$26.11 | Below P25 |
| BEDUYAPRINCER LLCNPI 1649249608 · Tax ID 862832506 | NV | 7 | $93.29 | -$19.80 | Below P25 |
| RH HOSPITALIST MEDICINE OF PERRY COUNTY LLCNPI 1821866740 · Tax ID 934172784 | MS | 3 | $99.19 | -$13.90 | P25 to median |
| HEALTHY LIFE PHYSICIANS GROUP PACIFIC NORTHWEST PCNPI 1336386218 · Tax ID 880645926 | TX | 26 | Median to P75 | ||
| JOVIVE HEALTHNPI 1255912622 · Tax ID 872422275 | FL | 10,881 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the hospitalist market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the hospitalist market.
- 1MULTISoutheastern Physician Services PCNPI 1083835441Medicare 67,307Medicaid 31,18098,487 total
- 2GAHospital Physician Services SE PCNPI 1760410385Medicare 35,574Medicaid 61,76697,340 total
- 3CAQuantum Healthcare Medical AssociatesNPI 1568490597Medicare 38,480Medicaid 18,80257,282 total
- 4FLEastSide Hospitalists INCNPI 1285676957Medicare 47,249Medicaid 7,82455,073 total
- 5MULTIOhio Physician Professional CorporationNPI 1417016973Medicare 43,912Medicaid 6,24550,157 total
- 6MULTIGalen Inpatient Physicians PCNPI 1558023911Medicare 23,157Medicaid 16,66039,817 total
- 7NVNevada Acute Medical Servs ManNPI 1992244438Medicare 9,784Medicaid 26,79036,574 total
- 8MIBeaumont Professional ServicesNPI 1811044878Medicare 22,536Medicaid 12,14834,684 total
- 9MULTIHospital Medicine Associates LLCNPI 1093758781Medicare 14,309Medicaid 20,33134,640 total
- 10MULTICorewell HealthNPI 1427567858Medicare 32,712Medicaid 28432,996 total
- 11ARSoutheastern Intensivist Services PCNPI 1912942665Medicare 16,843Medicaid 13,02029,863 total
- 12NJHospitalist Physicians Of New Jersey PANPI 1588021851Medicare 24,958Medicaid 4,50729,465 total
- 13SCSoutheastern Hospitalist Services PCNPI 1003280108Medicare 7,973Medicaid 20,03328,006 total
- 14INHospital Medicine Services of Tennessee PCNPI 1528433802Medicare 21,850Medicaid 5,55927,409 total
- 15MULTIUniv Of Penn Medical GroupNPI 1053447151Medicare 3,376Medicaid 23,80327,179 total
- 16MULTIEnloe Medical Center - EsplanadeNPI 1285327510Medicare 10,805Medicaid 16,30427,109 total
- 17MULTIChristiana Care Health Services INCNPI 1245474329Medicare 4,574Medicaid 21,62226,196 total
- 18MULTIHospital Of Central Connecticut At New Britain General And Bradley MeNPI 1063461481Medicare 15,049Medicaid 10,91025,959 total
- 19PATower Health Medical GroupNPI 1245321157Medicare 12,128Medicaid 12,34824,476 total
- 20FLHospital Physician Services Of FloridaNPI 1558718635Medicare 18,224Medicaid 5,45923,683 total
How reimbursement changes across hospitalist services
Keep initial, subsequent, observation, discharge, critical care, prolonged, and advance care planning services in their own encounter and time context.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 3 codes | ||||
99221Initial hospital or observation care, low complexity | $122.53 | $150.27 | $166.87 | $165.67 |
99222Initial hospital or observation care, moderate complexity | $164.21 | $218.96 | $233.20 | $242.60 |
99223Initial hospital or observation care, high complexity | $225.15 | $306.50 | $334.89 | $340.77 |
$ per service · 3 codes | ||||
99231Subsequent hospital or observation care, low complexity | $65.38 | $72.91 | $71.95 | $79.65 |
99232Subsequent hospital or observation care, moderate complexity | $93.91 | $124.11 | $126.68 | $135.01 |
99233Subsequent hospital or observation care, high complexity | $130.80 | $181.45 | $183.90 | $197.15 |
$ per service · 3 codes | ||||
99234Same-day hospital admission and discharge, low complexity | $144.65 | $193.08 | $216.13 | $221.03 |
99235Same-day hospital admission and discharge, moderate complexity | $199.27 | $272.88 | $288.08 | $310.29 |
99236Same-day hospital admission and discharge, high complexity | $256.44 | $350.94 | $370.84 | $397.44 |
$ per service · 2 codes | ||||
99238Hospital discharge management, 30 minutes or less | $95.36 | $127.04 | $128.89 | $140.12 |
99239Hospital discharge management, more than 30 minutes | $131.30 | $181.62 | $186.50 | $200.54 |
$ per service · 5 codes | ||||
99291Critical care, first 30–74 minutes | $344.35 | $414.65 | $482.59 | $486.44 |
99292Critical care, each additional 30 minutes | $162.59 | $193.46 | $213.11 | $219.80 |
99418Prolonged inpatient or observation care, each additional 15 minutes | $49.97 | $66.32 | $70.70 | $68.76 |
99497Advance care planning, first 30 minutes | $106.21 | $137.25 | $147.92 | $154.54 |
99498Advance care planning, each additional 30 minutes | $99.45 | $123.45 | $129.37 | $135.97 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to read these hospitalist rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
We start with negotiated or fee-schedule rates published in payer machine-readable files and included in the underlying professional hospitalist report. For each selected billing code, eligible records are grouped by payer and summarized as averages and percentile distributions.
- Rate source
- The displayed amount is a negotiated professional hospitalist rate published in a payer machine-readable file, not a paid claim, billed charge, or hospital facility payment.
- Rate calculation
- National values summarize eligible published records across available states. State views use records associated with the selected state, and averages are not weighted by inpatient volume, length of stay, or acuity. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file NPI and TIN records and may represent a hospitalist group, staffing organization, health system, or other billing entity. Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the encounter type, service level, time threshold, professional billing context, payer product, and network. Hospital facility reimbursement remains separate. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare Hospitalist rates in your market
Tell us the services, payers and locations you need. We'll confirm coverage and scope the comparison.
- Define the scopeChoose the codes, payers, networks and providers.
- Match the billing detailsWe align services, settings and payment units.
- Compare the ratesReview payer and provider rates for your selected market.
We'll explain what's available, flag gaps and help define the comparison.
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Explore hospitalist rates by state
Choose a state to compare payer reference averages for common services.
How to interpret hospitalist rates
How to interpret the selected market and payer-published rates.
Which hospitalist services are included?
The report covers initial and subsequent hospital care, observation care, discharge management, critical care, prolonged services, and advance care planning.
Why are initial and subsequent care separated?
They describe different encounters and levels of work, so each code should be benchmarked against the same service.
Do these rates include the hospital facility payment?
No. These are professional negotiated or fee-schedule rates associated with hospitalist services.
How should observation, discharge, and time-based services be compared?
Use the exact encounter and time code. Observation, same-day admission and discharge, discharge management, critical care, and prolonged services represent different work and should remain separate.
How are named hospitalist providers selected?
Provider examples are sampled across each payer's published rate range. An entity may represent a hospitalist group, staffing organization, health system, or other contracted billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.