CPT 99402 Fee Schedule

Finding the exact cost of a medical procedure can be complex due to varying insurance plans, provider agreements, and your individual deductible status. To get an estimate, you can contact your healthcare provider directly and ask for the CPT (Current Procedural Terminology) code for the service. With this code and your specific location, you can then use a tool like Payerprice to look up fee schedules and gain insight into potential costs.

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurers. They are essential for billing and help ensure consistent communication about medical procedures across the healthcare industry.

Insurance companies determine payments based on several factors, including negotiated rates with in-network providers, "usual, customary, and reasonable" (UCR) charges for out-of-network services, and the specifics of your insurance plan (deductibles, co-pays, co-insurance, and out-of-pocket maximums). These rates are often confidential and vary widely.

An "in-network" provider has a contract with your insurance company, agreeing to specific negotiated rates for services. When you see an in-network provider, your out-of-pocket costs (deductibles, co-pays, co-insurance) are typically lower. An "out-of-network" provider does not have a contract with your insurer. You may pay a higher percentage of the cost, and the provider might balance bill you for the difference between their charge and what your insurance pays.

Healthcare pricing is confusing due to a lack of transparency, complex billing systems, and varied negotiated rates between providers and insurers. Prices can differ significantly for the same service depending on the provider, location, and individual insurance plan, making it difficult for consumers to understand and compare costs upfront.