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Nationwide rates for HCPCS 99243

Office or other outpatient consultation for a new or 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, 30 minutes must be met or exceeded.

Facilitymedian $126 · 10th–90th $78$2240%20%40%10th90th$126Professionalmedian $112 · 10th–90th $72$2290%20%40%10th90th$112$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$66.07 / $104.71 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $213.80
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $100.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $100.00 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $134.90 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $131.83 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $100.00 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $263.03