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Pennsylvania rates for HCPCS 99241

Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $55 · 10th–90th $23–$760%10%20%10th90th$55Professionalmedian $55 · 10th–90th $26–$1050%10%20%10th90th$55$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $22.91
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $47.86 / $47.86
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $46.77 / $69.18
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $89.13 / $117.49
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $64.57 / $75.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $38.02 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $41.69 / $66.07