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Disability Evaluation by the Treating Doctor

Pennsylvania rates for HCPCS 99455

A dedicated visit in which the doctor already treating the patient assesses a work-related injury or disability claim: reviewing the history and records, examining the patient, forming an opinion on capability and restrictions, and completing the required reports and forms. It is separate from ordinary treatment of the condition itself.

Rates data updated July 2026.

How much does Disability Evaluation by the Treating Doctor cost?

$85.11

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $85.11 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$85.11$85.11 to $85.11
FacilityA hospital or hospital-owned outpatient department$85.11$85.11 to $117

How much rates vary

Facilitymedian $85 · 10th to 90th $85 to $363Professionalmedian $85 · 10th to 90th $60 to $126
$100$1K$10Kfacility $85professional $85

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$125.89
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$85.11
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$245.47
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$199.53
Typical High
$263.03
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$125.89
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$208.93
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$363.08
Typical High
$380.19
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$67.61
Typical High
$331.13

Where Pennsylvania sits

The same service costs 3.5 times more in Illinois than in North 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· 17th of 51

$85.11

IL $263NC $75.86

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.