Reddenda · Rate Intelligence · Scranton--Wilkes-Barre, PA
99213 under Bcbsnm in Scranton--Wilkes-Barre, PA
Office visit, established patient, 20-29 min · Local peer median $114.80 · Medium confidence
Local distribution · 377 providers · 383 rate records
- The local peer median for CPT 99213 under Bcbsnm in Scranton--Wilkes-Barre, PA is $114.80, drawn from 377 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- The bottom of the local market (P10) is $97.58 and the top (P90) is $114.80; the median-to-P90 spread is $0.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- The lowest published rate in this market is $24; the highest is $181.03.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- This benchmark is drawn from 383 individual rate records that Bcbsnm itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- Medicare's national non-facility rate for CPT 99213 is $95.19, making the Bcbsnm local median 121% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- 50.7% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate
- A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)
377 providers bill this code to this payer in this metro.
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This is the local market for CPT 99213 (Office visit, established patient, 20-29 min) under Bcbsnm in Scranton--Wilkes-Barre, PA. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.
Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.
Modeled from Bcbsnm's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsnm to publish this rate. Page generated 2026-08-23 23:49 UTC; the live index is queried in real time on every request.