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HCPCS 99459

Pelvic exam

Reported by 7 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$23

Average

$46

Median

$37

High

$116

Hospitals reporting this code

#HospitalLocation
1Northwest Medical Foundation Of TillamookTillamook, OR$55$116$116$319—
2Ukiah Adventist HospitalUkiah, CA$22$24$23$505$1
3Adventist Health Medical Center TehachapiTehachapi, CA$24$31$31$685$2
4Sonora Community HospitalSonora, CA$29$38$37$274$2
5Reedley Community HospitalReedley, CA$19$26$26$676$1
6Lodi Memorial Hospital Association IncLodi, CA$15$51$51$304—
7Willits Hospital IncWillits, CA$11$37$37$407—

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