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Pennsylvania rates for HCPCS 99231

Subsequent 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 of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

Facilitymedian $43 · 10th–90th $30–$850%20%10th90th$43Professionalmedian $59 · 10th–90th $32–$1100%10%10th90th$59$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
$29.51 / $42.66 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $57.54 / $104.71
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$47.86 / $83.18 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $63.10 / $87.10
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $38.90 / $51.29
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
$48.98 / $51.29 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $50.12 / $75.86
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $33.11
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $61.66 / $87.10
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $41.69
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $56.23 / $77.62
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $77.62
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$42.66 / $44.67 / $44.67
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $38.90 / $51.29
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $30.90 / $81.28
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $66.07 / $114.82
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $43.65 / $52.48
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $69.18 / $83.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $45.71 / $60.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.80 / $45.71 / $60.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $46.77 / $85.11