go back

California 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 $117 · 10th–90th $83–$2090%20%10th90th$117Professionalmedian $123 · 10th–90th $78–$3980%20%10th90th$123$0.0$0.2$2.0$20.0$200.0$2.0K

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
$83.18 / $114.82 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $123.03 / $398.11
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $204.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $138.04 / $223.87
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $89.13
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $169.82 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $138.04 / $234.42
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $58.88 / $89.13
HealthNet
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $331.13 / $537.03
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $66.07 / $158.49
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $147.91 / $213.80
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $134.90 / $204.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $269.15
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $89.13 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $114.82 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $218.78