CPT 99223
Initial hospital or observation care, high complexity
- Aetna
- $169.09
- Cigna
- $254.72
- United
- $310.96
- Anthem
- $291.31
Hospitalist reimbursement rates in South Carolina
Explore hospitalist reimbursement rates in South Carolina. Public state reference averages appear below. Detailed payer comparisons are available with a state preview.
4,187,775 national provider-rate observations4 payers in national source data50 states in national dataset16 billing codes in national dataset
Rate data shownJun–Jul 2026About these rates
Hospitalist rate explorerThree reference services
Rate measure$ per service
Billing contextProfessional inpatient medicine
South Carolina hospitalist reference averages
Publication period: Jun–Jul 2026CPT 99232
Subsequent hospital or observation care, moderate complexity
- Aetna
- $74.11
- Cigna
- $106.26
- United
- $115.86
- Anthem
- $116.19
CPT 99233
Subsequent hospital or observation care, high complexity
- Aetna
- $106.18
- Cigna
- $157.13
- United
- $168.21
- Anthem
- $168.93
National hospitalist rates by payer
Compare national payer rates for common inpatient encounters and see how reimbursement changes across the hospital stay.
Aetna state variation for 99233
LowerHigher
South Carolina
Select a state to reveal payer percentiles and provider examples.National 99233 rate distribution
PayerMedian
Published rate$ per service
$100$150$200$250$300
AetnaJun–Jul 2026
AetnaProviders57,313Average$130.80
$113.09median
CignaJun–Jul 2026
CignaProviders67,380Average$181.45
$163.88median
UnitedJun–Jul 2026
UnitedProviders62,353Average$183.90
$168.55median
AnthemJun–Jul 2026
AnthemProviders69,501Average$197.15
$191.33median
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 |
About these rates
About this rate table
- 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.
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 |
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No trial or data preparation required.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 |
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Book a 20-min scoping call No trial or data preparation required.How these hospitalist rates are calculated
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 sourceThe 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.
- CalculationNational 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.
- Provider entityNamed examples use payer-file NPI and TIN records and may represent a hospitalist group, staffing organization, health system, or other billing entity.
- Comparable ratesMatch the encounter type, service level, time threshold, professional billing context, payer product, and network. Hospital facility reimbursement remains separate.
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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?
The public table selects billing entities across each payer's published rate range. An entity may represent a hospitalist group, staffing organization, health system, or other contracted billing organization.