Average Medicaid Office Visit Payments in Pocono Summit, PA: $58.52
Avg. Paid
$58.52
Range
$27.20 – $91.84
Total Claims
2,597
Providers
4
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Understanding these costs
The amounts shown are Medicaid reimbursement rates — what state Medicaid programs paid providers per claim. Medicaid typically pays well below private insurance rates and out-of-pocket prices. Use this data to compare relative costs between providers, not as a price estimate for privately insured or self-pay patients.
Providers Offering Office Visit in Pocono Summit, PA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Kartik Rai
174 Harvest Ln |
$60.77 | 1,458 | 1,397 |
|
Cathy Nicole Richards
174 Harvest Ln |
$37.70 | 672 | 621 |
|
Jennifer Jean Mcgovern
158 Joseph Lane |
$91.84 | 392 | 356 |
|
Lindsey Connors Kelly
2657 Route 940 Unit 110 |
$27.20 | 75 | 73 |
What to Expect: Office Visit
A typical office visit lasts 15-45 minutes depending on complexity. Your doctor will review your medical history, discuss symptoms, perform a physical exam, and discuss treatment options. You may receive prescriptions, referrals, or orders for diagnostic tests. Follow-up visits are usually shorter than new patient visits.
Cost Components
National average Medicaid payment per billing code. Individual rates vary by provider and state.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These are national Medicaid averages for each billing code. Actual amounts vary by state, provider, and complexity.
Frequently Asked Questions
How much does a Office Visit cost in Pocono Summit, PA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Office Visit in Pocono Summit, PA is $58.52 per claim, based on 2,597 claims from 4 providers. Typical payments fall between $29.28 and $67.92. Note: Medicaid rates are typically much lower than private insurance or self-pay prices.
How many providers offer Office Visit in Pocono Summit, PA?
There are 4 Medicaid providers offering Office Visit related services in Pocono Summit, PA according to public payment data.
What is the price range for Office Visit in Pocono Summit, PA?
Medicaid reimbursement for Office Visit in Pocono Summit, PA ranges from $27.20 to $91.84 per claim, with an average of $58.52. Private insurance and self-pay costs are typically higher than these Medicaid rates.
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