Price Checker / CPT 99153
How much does Mod Sed Same Phys/qhp Ea cost?
CPT 99153 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is around 63x the fair price — among the most extreme markups. Dispute this.
Fair price
$20–$35
What this should cost
With insurance
~$570
Typical out-of-pocket
Overcharged if over
$45
Push back above this
The average hospital charge of $1,902 is $1,872 over the fair price (about 63x the fair rate).
What hospitals charge for Mod Sed Same Phys/qhp Ea
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| United Memorial Medical Center BATAVIA, NY | $5,714 | $3,714 | 46129% |
| HCA HOUSTON HEALTHCARE CLEAR LAKE Webster, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE CONROE Conroe, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE KINGWOOD Kingwood, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE MEDICAL CENTER Houston, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE PEARLAND Pearland, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE SOUTHEAST Pasadena, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE TOMBALL Tomball, TX | — | — | 37845% |
| HCA HOUSTON HEALTHCARE WEST Houston, TX | — | — | 37845% |
| THE WOMANS HOSPITAL OF TEXAS Houston, TX | — | — | 37845% |
| UPMC Carlisle CARLISLE, PA | $1,246 | $748 | 9981% |
| UPMC Community Osteopathic , PA | $1,246 | $748 | 9981% |
| UPMC Harrisburg , PA | $1,246 | $748 | 9981% |
| UPMC Memorial YORK, PA | $1,246 | $748 | 9981% |
| UPMC West Shore , PA | $1,246 | $748 | 9981% |
Were you billed for this procedure?
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About Mod Sed Same Phys/qhp Ea
CPT code 99153 refers to mod sed same phys/qhp ea (billing description: "Mod sed same phys/qhp ea"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $12 in a facility (hospital or surgery center) and $12 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.