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Pennsylvania rates for HCPCS 99222

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 moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $112 · 10th–90th $102–$2880%50%10th90th$112Professionalmedian $145 · 10th–90th $100–$3310%20%10th90th$145$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
$102.33 / $109.65 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $338.84
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $229.09
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $11,220.18 / $28,840.32
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $141.25 / $154.88
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
$138.04 / $194.98 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $162.18 / $234.42
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $162.18 / $229.09
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $138.04
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $257.04
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $138.04 / $194.98
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $10,715.19 / $22,908.68
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $158.49
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $141.25
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $138.04 / $275.42
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $138.04 / $169.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $204.17 / $295.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $131.83 / $416.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $114.82 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $147.91 / $269.15