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Pennsylvania rates for HCPCS 99233

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 high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.

Facilitymedian $89 · 10th–90th $78–$2040%20%10th90th$89Professionalmedian $120 · 10th–90th $78–$2630%20%10th90th$120$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
$77.62 / $85.11 / $173.78
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $120.23 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $131.83 / $208.93
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $107.15 / $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
$117.49 / $169.82 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $125.89 / $194.98
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $147.91 / $208.93
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $107.15
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $138.04 / $199.53
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $186.21
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $107.15 / $120.23
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $85.11 / $120.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $107.15 / $208.93
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $117.49 / $128.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $186.21 / $223.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $27.54 / $117.49
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $75.86 / $218.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $208.93