Price Checker / CPT 99155
How much does Mod Sed Oth Phys/qhp <5 Yrs cost?
CPT 99155 · Based on 2026 Medicare rates and hospital-published pricing
A fair cash price for this is roughly $250–$300.
Fair price
$250–$300
What this should cost
With insurance
~$670
Typical out-of-pocket
Overcharged if over
$380
Push back above this
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Mod Sed Oth Phys/qhp <5 Yrs
CPT code 99155 refers to mod sed oth phys/qhp <5 yrs (billing description: "Mod sed oth phys/qhp <5 yrs"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $82 in a facility (hospital or surgery center) and $82 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.