go back

Pennsylvania rates for HCPCS 99305

Initial nursing facility 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, 35 minutes must be met or exceeded.

Facilitymedian $100 · 10th–90th $98–$2140%20%10th90th$100Professionalmedian $126 · 10th–90th $98–$2450%20%10th90th$126$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
$97.72 / $100.00 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $245.47
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $190.55
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $138.04
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
$109.65 / $128.82 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $154.88 / $213.80
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $234.42
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $138.04
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $100.00 / $123.03
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $123.03 / $218.78
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $144.54 / $162.18
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $144.54 / $162.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $117.49 / $562.34
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $120.23 / $562.34
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $138.04 / $218.78