{
  "query": {
    "country": "US",
    "service": "99213",
    "state": null,
    "setting": null
  },
  "status": "ok",
  "price": {
    "currency": "USD",
    "unit": "per service (Medicare-allowed amount)",
    "value": 85.366781205,
    "measure": "average",
    "median": null,
    "typical_low": null,
    "typical_high": null,
    "min": null,
    "max": null
  },
  "sample_size": 64778139,
  "period": {
    "from": "2024-01-01",
    "to": "2024-12-31"
  },
  "confidence": "high",
  "price_type": "official_statistic",
  "statistic": {
    "measure": "average",
    "reference_period": "2024",
    "note": "Office setting: the Medicare-allowed amount for the whole service (doctor, staff and equipment). This is what Medicare allowed (Medicare's payment plus the patient's deductible and coinsurance), not what private insurance pays or the cash price; private-insurance and cash prices are usually higher. The other setting (facility) is shown under other_setting."
  },
  "as_of": "2026-10-14T21:16:22.434Z",
  "source": {
    "id": "us-cms-physician",
    "name": "Medicare Physician & Other Practitioners - by Geography and Service",
    "publisher": "Centers for Medicare & Medicaid Services (CMS)",
    "licence": "U.S. Government Works (the licence the Data.gov catalog lists for this dataset; no separate licence is stated on data.cms.gov). CPT(R) codes and descriptions in the CMS files are covered by the AMA licence: \"CPT codes, descriptions and other data only are copyright 1995 - 2025 American Medical Association.\" and \"CPT is a registered trademark of the American Medical Association (AMA).\" (https://www.cms.gov/license/ama). ProofPrice passes on Medicare payment amounts and the code numbers a caller supplies, and writes its own plain labels; it does not copy the CMS/AMA code descriptions.",
    "licence_url": "https://www.usa.gov/government-works",
    "attribution": "Source: Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners - by Geography and Service (data.cms.gov). Amounts are what Medicare allowed for services to Medicare fee-for-service patients, passed on as published. CPT is a registered trademark of the American Medical Association (AMA); CPT codes and descriptions are copyright AMA.",
    "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-geography-and-service"
  },
  "method": "CMS publishes, once a year, the average Medicare-allowed amount for each billing code in each setting (office or facility), state and the nation, for Medicare fee-for-service patients (dataset Medicare Physician & Other Practitioners - by Geography and Service). ProofPrice returns the published average for the latest data year, unchanged, with the number of services behind it, the share Medicare itself paid and the national average for comparison. No range is calculated: CMS gives one average per code, setting and place. It is what Medicare allowed, not a private-insurance or cash price.",
  "method_url": "https://proofprice.com/method",
  "summary": "For established-patient office visit, level 3 (low complexity) (code 99213) in the United States, Medicare allowed an average of $85.37 per service in 2024 in an office (non-facility) setting, across 64,778,139 services. Medicare itself paid $59.32 of that on average; the patient's share and any other insurer cover the rest. This is what Medicare allowed (its payment plus the patient's cost-sharing), not a private-insurance or cash price and not the provider's billed (list) charge. Official average published by Centers for Medicare & Medicaid Services (CMS) for 2024.",
  "notice": "Information, not a valuation or offer. Ranges describe past recorded prices.",
  "extra": {
    "code": "99213",
    "service": "established-patient office visit, level 3 (low complexity)",
    "service_group": "established-patient office visit",
    "code_system": "CPT (copyright American Medical Association)",
    "what_it_is": "average Medicare-allowed amount, not a private-insurance or cash price",
    "geography": {
      "level": "National",
      "name": "National",
      "code": null
    },
    "setting": "office",
    "average_medicare_allowed_amount": 85.37,
    "average_medicare_payment": 59.32,
    "services": 64778139,
    "beneficiaries": 18637816,
    "providers": 631995,
    "average_billed_charge_not_a_price_paid": 189.25,
    "national": null,
    "other_setting": {
      "setting": "facility",
      "average_medicare_allowed_amount": 61.15,
      "services": 4505351,
      "what_it_covers": "the doctor's professional fee only"
    },
    "data_year": 2024,
    "dataset": {
      "name": "Medicare Physician & Other Practitioners - by Geography and Service",
      "id": "6fea9d79-0129-4e4c-b1b8-23cd86a4f435",
      "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-geography-and-service"
    },
    "notes": [
      "Office setting: the Medicare-allowed amount for the whole service (doctor, staff and equipment).",
      "This is what Medicare allowed (Medicare's payment plus the patient's deductible and coinsurance), not what private insurance pays or the cash price; private-insurance and cash prices are usually higher.",
      "The other setting (facility) is shown under other_setting."
    ]
  },
  "answer_id": "ans_343644d165bad0e5b4b7",
  "method_version": "1",
  "retrieved_at": "2026-10-14T21:16:22.434Z",
  "evidence": {
    "type": "official_statistic",
    "label": "Official published average",
    "meaning": "One average or median that a statistics office or regulator publishes for a reference period: it describes a group, not a distribution, and says nothing about any single price."
  }
}