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Pennsylvania rates for HCPCS 99381

Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)

Facilitymedian $102 · 10th–90th $63$2190%10%20%10th90th$102Professionalmedian $120 · 10th–90th $66$2510%10%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
$63.10 / $102.33 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $123.03 / $257.04
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $144.54
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $123.03 / $134.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $123.03 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $107.15 / $173.78
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $134.90 / $234.42
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $89.13 / $169.82
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $93.33 / $95.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $134.90 / $169.82
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $186.21 / $186.21
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $93.33 / $162.18
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $186.21
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $138.04 / $281.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $102.33 / $123.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $102.33 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $100.00 / $173.78