Extended office or other outpatient service by clinical staff, first hour
Medicare pricing data for 430 providers across 27 states
Prices vary significantly by location — from $11 in Minnesota to $23 in New York. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Extended office or other outpatient service by clinical staff, first hour (HCPCS code 99415) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $19.41, but hospitals typically charge $52.77 — a 2.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $19.41, your out-of-pocket cost would be approximately $3.88. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $15.08 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New York | $23 | $122 | 13 | 35 | +16.2% |
| Washington | $22 | $30 | 10 | 856 | +14.7% |
| Virginia | $22 | $210 | 9 | 92 | +12.8% |
| California | $22 | $53 | 57 | 1,997 | +11.5% |
| New Jersey | $21 | $62 | 14 | 288 | +10.1% |
| Massachusetts | $20 | $50 | 10 | 210 | +2.7% |
| Rhode Island | $20 | $45 | 1 | 41 | +1.6% |
| Maryland | $20 | $89 | 3 | 23 | +1.2% |
| Pennsylvania | $20 | $45 | 7 | 209 | +0.7% |
| Arizona | $19 | $77 | 8 | 21 | -0.4% |
| Texas | $18 | $30 | 47 | 1,093 | -5.6% |
| Nevada | $18 | $79 | 8 | 987 | -6.7% |
| Florida | $18 | $61 | 49 | 241 | -7.3% |
| Michigan | $17 | $49 | 20 | 272 | -11.2% |
| North Carolina | $17 | $51 | 15 | 202 | -12.0% |
| Ohio | $17 | $78 | 10 | 56 | -12.8% |
| Indiana | $17 | $31 | 9 | 139 | -13.1% |
| Tennessee | $17 | $54 | 11 | 108 | -13.2% |
| Colorado | $17 | $27 | 6 | 13 | -14.7% |
| Missouri | $16 | $68 | 5 | 13 | -15.0% |
| South Carolina | $16 | $35 | 8 | 12 | -15.5% |
| Georgia | $16 | $62 | 9 | 21 | -16.1% |
| Wisconsin | $16 | $35 | 11 | 17 | -16.2% |
| Illinois | $16 | $38 | 25 | 407 | -17.0% |
| Louisiana | $16 | $106 | 5 | 166 | -19.3% |
| Arkansas | $16 | $36 | 8 | 35 | -19.7% |
| Minnesota | $11 | $79 | 8 | 24 | -44.9% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber