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Pennsylvania rates for HCPCS 99385

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; 18-39 years

Facilitymedian $126 · 10th–90th $102$3090%20%10th90th$126Professionalmedian $148 · 10th–90th $89$3020%10%20%10th90th$148$50.0$200.0$1.0K$5.0K$20.0K

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
$102.33 / $125.89 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $151.36 / $316.23
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $131.83 / $173.78
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $151.36
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
$138.04 / $144.54 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $128.82 / $213.80
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $158.49 / $275.42
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $102.33 / $199.53
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $100.00 / $281.84
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $138.04 / $181.97
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $158.49
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $114.82 / $309.03
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $117.49 / $223.87
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $138.04 / $165.96
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $123.03
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $134.90 / $295.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $107.15 / $125.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $107.15 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $123.03 / $204.17