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North Carolina rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $224 · 10th–90th $151–$3800%10%10th90th$224Professionalmedian $251 · 10th–90th $151–$5620%5%10%10th90th$251$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $416.87
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$42.66 / $245.47 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $575.44
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $281.84 / $660.69
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $338.84
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$177.83 / $229.09 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $281.84 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $229.09 / $407.38
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $407.38
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $223.87 / $354.81
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $512.86
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $302.00 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $229.09 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $199.53 / $338.84
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $89.13 / $269.15
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,380.38