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Case Management

Pennsylvania rates for HCPCS T1016

Case management, each 15 minutes

Rates data updated July 2026.

How much does Case Management cost?

$9.55

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $9.55 for this service. The price depends on where it is billed: about $9.55 from a physician practice, and about $37.15 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 6 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$9.55$9.55 to $9.55
FacilityA hospital or hospital-owned outpatient department$37.15$30.90 to $51.29

How much rates vary

Facilitymedian $37 · 10th to 90th $10 to $87Professionalmedian $10 · 10th to 90th $6 to $38
$1.0$5.0$20.0$100.0facility $37professional $10

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
$9.55
Median
$34.67
Typical High
$37.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$9.55
Typical High
$38.02
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$34.67
Typical High
$37.15
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$9.55
Typical High
$13.80
Optum
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$15.49
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.47
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$66.07
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$15.49

Where Pennsylvania sits

The same service costs 3.3 times more in North Dakota than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Pennsylvania $9.55 · 30th of 51
ND $31.62DC $9.55

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.