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Massachusetts rates for HCPCS 99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $93 · 10th–90th $36$3160%5%10th90th$93Professionalmedian $89 · 10th–90th $50$2190%10%10th90th$89$2.0$10.0$50.0$200.0$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
$48.98 / $93.33 / $194.98
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$120.23 / $199.53 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $87.10 / $208.93
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$51.29 / $91.20 / $229.09
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$257.04 / $269.15 / $269.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $218.78 / $630.96
AllWays Health Partners
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
AllWays Health Partners
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$41.69 / $41.69 / $41.69
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $269.15
AllWays Health Partners
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$35.48 / $56.23 / $114.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $109.65 / $173.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $128.82 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $89.13 / $173.78
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $48.98 / $91.20
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $83.18 / $154.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $125.89 / $229.09
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $102.33 / $295.12
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $134.90 / $295.12
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $218.78 / $630.96
Mass General Brigham
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Mass General Brigham
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$41.69 / $41.69 / $41.69
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $269.15
Mass General Brigham
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$35.48 / $56.23 / $114.82
Tufts
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $125.89
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $69.18 / $154.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $95.50 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $95.50 / $213.80
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $89.13 / $128.82