Assisted Living Visit, New Patient, High Complexity

Pennsylvania rates for HCPCS 99328

A first visit by a doctor or other qualified provider to a patient living in an assisted living residence, rest home, or similar place that provides housing and personal care rather than skilled nursing. This is the highest level, used when the patient is unstable or has serious conditions that interact, so the assessment and the decisions are extensive.

Rates data updated October 2026.

How much does Assisted Living Visit, New Patient, High Complexity cost?

$170

Typical facility fee. In Pennsylvania, October 2026.

Insurers have agreed to pay about $170 for this service. Most negotiated rates run $170 to $170.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $95 · 10th to 90th $95 to $95Professionalmedian $170 · 10th to 90th $170 to $182

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier	Facility/Professional	Modifier	Typical Low	Median	Typical High
Emblem Health Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50	Facility	None	$95.50	$95.50	$95.50
Geisinger Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97	Professional	None	$181.97	$181.97	$181.97
UPMC Health Plan Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $169.82	Professional	None	$169.82	$169.82	$169.82

Where Pennsylvania sits

The same service costs 33.9 times more in Texas than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 32nd of 33

$170

TX $1,023SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.