What is the top of the local market (P90) for CPT 99222 under Bcbs Mi for Toledo, OH providers?

The P90, the top of the local market and Reddenda's target rate, is $137.73.

How does Bcbs Mi's rate for CPT 99222 compare to Medicare?

The Bcbs Mi local median of $137.73 is 118% of Medicare's national non-facility rate of $116.90 for CPT 99222.

Reddenda · Rate Intelligence · Toledo, OH

99222 under Bcbs Mi, for Toledo, OH providers

Name: Bcbs Mi rates for CPT 99222 among Toledo, OH providers
Creator: Reddenda

Initial hospital care, moderate · Local peer median $137.73 · Medium confidence

$137.73 local peer median. Bcbs Mi's published rate file lists a local peer median of $137.73 for CPT 99222 (Initial hospital care, moderate) among 105 indexed providers in Toledo, OH. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $137.73, which is the same as the median here: this payer's filed rates for this code cluster on one number, so the opportunity in this cell is reaching the median rather than exceeding it. A provider billed below this median is being paid less than peers holding the identical Bcbs Mi contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 105 providers · 105 rate records

P10

$117.07

P25

$137.73

Median

$137.73

P75

$137.73

P90 (target)

$137.73

P10$117.07

P25$137.73

Median (P50)$137.73

P75$137.73

P90 target$137.73

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $117.07 – $137.73

The local peer median for CPT 99222 under Bcbs Mi for Toledo, OH providers is $137.73, drawn from 105 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
The bottom of the local market (P10) is $117.07 and the top (P90) is $137.73; the median-to-P90 spread is $0.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
The lowest published rate in this market is $117.07; the highest is $137.73.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
This benchmark is drawn from 105 individual rate records that Bcbs Mi itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
Medicare's national non-facility rate for CPT 99222 is $116.90, making the Bcbs Mi local median 118% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
85.7% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

105 providers bill this code to this payer in this metro.

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These are the rates Bcbs Mi publishes for CPT 99222 (Initial hospital care, moderate) among Toledo, OH providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Bcbs Mi's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Mi to publish this rate. Page generated 2026-08-23 23:47 UTC; the live index is queried in real time on every request.