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Iowa 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 $155 · 10th–90th $85–$2340%10%10th90th$155Professionalmedian $112 · 10th–90th $71–$2880%5%10%10th90th$112$1.0$5.0$20.0$100.0$500.0

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
$144.54 / $199.53 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $120.23 / $223.87
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $165.96 / $426.58
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $128.82 / $229.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $213.80 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $213.80 / $363.08
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $218.78
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $117.49 / $251.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $120.23 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $251.19
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $128.82 / $158.49