Outpatient office visit, established patient at Champlain Valley Physicians Hospital Medical Center

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN

Plattsburgh, NY

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Pricing by billing methodology

Price type

How this price compares nationally

Champlain Valley Physicians Hospital Medical Center’s median price of $90 is 27% below the median hospital's median price ($124), higher than 30% of the 2,009 hospitals reporting CPT 99213. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 99213 at Champlain Valley Physicians Hospital Medical Center

Negotiated rates from the hospital’s own file: 7 payers, 32 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Aetna medicare advantage professional · fee schedule · both	$61.92	$61.92	$61.92 – $61.92
2	Blue Cross Blue Shield managed medicaid aliessa professional · fee schedule · both	$61.92	$61.92	$61.92 – $61.92
3	Blue Cross Blue Shield medicare advantage professional · fee schedule · both	$61.92	$61.92	$61.92 – $61.92
4	Excellus medicare advantage professional · fee schedule · both	$61.92	$61.92	$61.92 – $61.92
5	Humana tricare professional · fee schedule · both	$61.92	$61.92	$61.92 – $61.92
6	UnitedHealthcare managed medicaid/essential plans professional · fee schedule · both	$64.40	$64.40	$64.40 – $64.40
7	Excellus managed medicaid/essential plans professional · fee schedule · both	$70.06	$70.06	$70.06 – $70.06
8	Blue Cross Blue Shield essential plans/managed medicaid professional · fee schedule · both	$74.30	$74.30	$74.30 – $74.30
9	UnitedHealthcare medicare advantage professional · fee schedule · both	$85.86	$85.86	$85.86 – $85.86
10	Excellus managed medicaid/essential plans facility · percent of total billed charges · outpatientfrom % of charges	$86.20	$86.20	$86.20 – $86.20
11	Highmark ind/fep professional · fee schedule · both	$90.33	$90.33	$90.33 – $90.33
12	Highmark ppo/hmo professional · fee schedule · both	$90.33	$90.33	$90.33 – $90.33
13	Aetna commercial professional · fee schedule · both	$91.02	$91.02	$91.02 – $91.02
14	Excellus commercial professional · fee schedule · both	$92.11	$92.11	$92.11 – $92.11
15	Blue Cross Blue Shield individual network professional · fee schedule · both	$99.07	$99.07	$99.07 – $99.07
16	UnitedHealthcare commercial ppo for ny state employees professional · fee schedule · both	$106.68	$106.68	$98.03 – $115.33
17	Blue Cross Blue Shield blue access professional · fee schedule · both	$139.75	$139.75	$139.75 – $139.75
18	Blue Cross Blue Shield hmo professional · fee schedule · both	$146.99	$146.99	$146.99 – $146.99
19	Blue Cross Blue Shield ind professional · fee schedule · both	$146.99	$146.99	$146.99 – $146.99
20	Blue Cross Blue Shield ppo professional · fee schedule · both	$146.99	$146.99	$146.99 – $146.99
21	Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges	$155.16	$155.16	$155.16 – $155.16
22	UnitedHealthcare commercial professional · fee schedule · both	$203.33	$203.33	$203.33 – $203.33
23	Blue Cross Blue Shield blue access facility · percent of total billed charges · outpatientfrom % of charges	$262.91	$262.91	$262.91 – $262.91
24	Blue Cross Blue Shield hmo facility · percent of total billed charges · outpatientfrom % of charges	$275.84	$275.84	$275.84 – $275.84
25	Blue Cross Blue Shield ind facility · percent of total billed charges · outpatientfrom % of charges	$275.84	$275.84	$275.84 – $275.84

Page 1 of 2 · 32 rates

Last updated: Apr 28, 2026

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