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Pennsylvania rates for HCPCS 99221

Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Facilitymedian $123 · 10th–90th $78–$3,6310%10%10th90th$123Professionalmedian $107 · 10th–90th $66–$2190%10%20%10th90th$107$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $489.78
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$891.25 / $4,265.80 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $107.15 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $107.15 / $144.54
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $346.74 / $9,120.11
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $117.49
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $128.82 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $109.65 / $169.82
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $104.71 / $147.91
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $100.00
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $104.71 / $186.21
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $91.20 / $131.83
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $309.03 / $4,570.88
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $117.49
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $81.28 / $173.78
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $208.93
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $87.10 / $125.89
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $5,623.41 / $7,079.46
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $151.36 / $218.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $102.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.72 / $33.88 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $199.53