Average Medicaid Office Visit Payments in Sunbury, PA: $40.10
Avg. Paid
$40.10
Range
$2.19 – $155.60
Total Claims
40,237
Providers
13
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 Sunbury, PA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
David Raymond Kalodner
409 N 4Th St |
$38.75 | 12,320 | 11,000 |
|
Stephen A. Lewis
385 State St |
$37.54 | 8,289 | 7,972 |
|
Thomas A. Hepner
385 State St |
$41.25 | 6,138 | 5,869 |
|
Jessica Barbara Pagana-Defazio
1072 Market St |
$44.04 | 3,719 | 3,314 |
|
Brian Daniel Timms
385 State St |
$38.21 | 2,872 | 2,823 |
|
Olivia Fladmark
1151 N 4Th St |
$41.97 | 2,681 | 2,556 |
|
Kathleen E Horne
409 N 4Th St |
$35.83 | 1,589 | 1,506 |
|
Matthew David Wolcott
385 State St |
$70.92 | 1,489 | 1,405 |
|
Mahmood Nasir
512 Market St |
$18.92 | 1,060 | 1,029 |
|
Emily Ann Haas
1072 Market St |
$2.19 | 32 | 30 |
|
Fred Teichman
301 Arch St |
$45.33 | 24 | 24 |
|
Pat J. Bruno
218 Chestnut St |
$155.60 | 12 | 12 |
|
Andrew Fabian
330 N. 12Th St. |
$8.80 | 12 | 12 |
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 Sunbury, PA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Office Visit in Sunbury, PA is $40.10 per claim, based on 40,237 claims from 13 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 Sunbury, PA?
There are 13 Medicaid providers offering Office Visit related services in Sunbury, PA according to public payment data.
What is the price range for Office Visit in Sunbury, PA?
Medicaid reimbursement for Office Visit in Sunbury, PA ranges from $2.19 to $155.60 per claim, with an average of $40.10. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Office Visit in Other Cities
Brooklyn, NY
Avg $71.20
32,336,840 claims · 5588 providers
New York, NY
Avg $81.86
23,551,154 claims · 7530 providers
Los Angeles, CA
Avg $24.20
16,948,065 claims · 5565 providers
Chicago, IL
Avg $30.31
13,989,780 claims · 5801 providers
Bronx, NY
Avg $82.40
13,626,712 claims · 3705 providers
Phoenix, AZ
Avg $47.53
13,269,420 claims · 4233 providers
Houston, TX
Avg $48.27
8,766,644 claims · 4540 providers
Las Vegas, NV
Avg $54.47
8,578,324 claims · 3512 providers
Other Procedures in Sunbury, PA
Case Management Services
Avg $80.42
29,071 claims
Physical Therapy
Avg $53.32
24,168 claims
Emergency Room Visit
Avg $103.55
23,822 claims
Blood Work & Lab Tests
Avg $8.71
15,241 claims
Speech Therapy
Avg $16.65
7,883 claims
Ambulance Transport
Avg $210.63
3,239 claims
Chiropractic Care
Avg $10.87
2,475 claims
Eye Exam
Avg $30.84
2,464 claims