What every payer pays for 97116 in Pennsylvania
Across 11 commercial payers in Pennsylvania, the middle payer's median for 97116 (physician and practitioner services (fee schedule)) is $27.46 per 15 min. Pennsylvania Medicaid's fee-for-service rate, $8.38 per 15 min, is 70% below that commercial median.
- Commercial median
- $27.46per 15 min
- Pennsylvania Medicaid
- $8.38
- Medicare
- $27.92+
On this page
97116 in Pennsylvania, by payer type
Medicare's physician fee schedule pays $27.92–$29.96 in Pennsylvania across 2 localities.
Each payer's 97116 rate in Pennsylvania
Frequently asked questions
What do commercial payers pay for 97116 in Pennsylvania?
The median of 11 payers' medians is $27.46 per 15 min, from 427 published rates in the October 2026 files.
How does Pennsylvania Medicaid compare with commercial insurance for 97116?
Pennsylvania Medicaid pays $8.38 per 15 min, 70% below the commercial median.
What does Medicare pay for 97116 in Pennsylvania?
$27.92 to $29.96 on the RVU26B physician fee schedule (non-facility).
What does UnitedHealthcare pay for 97116 in Pennsylvania?
UnitedHealthcare's median is $27.11 per 15 min, from 210 rates and 875 providers.
What does Horizon BCBS NJ pay for 97116 in Pennsylvania?
Horizon BCBS NJ's median is $27.46 per 15 min, from 52 rates and 155 providers.