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Pennsylvania rates for HCPCS 99416

Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service)

Professionalmedian $6 · 10th–90th $4–$140%10%20%10th90th$6$1.0$2.0$5.0$10.0$20.0$50.0$100.0

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
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $5.01 / $10.47
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.62 / $5.89
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.41 / $9.55 / $10.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $7.08 / $13.80
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.80 / $19.95 / $26.30
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.69 / $12.88 / $20.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.07 / $1.07 / $8.91
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.89 / $5.89
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.47 / $5.01 / $8.91
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $6.46 / $11.75
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.71 / $19.50 / $24.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $8.13 / $9.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.80 / $5.62 / $14.13