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Pennsylvania rates for HCPCS 99223

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 high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Facilitymedian $170 · 10th–90th $151–$6310%20%10th90th$170Professionalmedian $204 · 10th–90th $135–$4570%20%10th90th$204$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$151.36 / $169.82 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $204.17 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $204.17 / $302.00
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $229.09
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
$162.18 / $190.55 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $218.78 / $338.84
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
$114.82 / $218.78 / $309.03
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $204.17
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $218.78 / $389.05
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $194.98 / $269.15
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $204.17 / $234.42
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $158.49 / $208.93
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $389.05
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $181.97 / $251.19
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $295.12 / $436.52
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $131.83 / $199.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $131.83 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $213.80 / $398.11