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Maryland 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 $98 · 10th–90th $72–$1290%10%20%10th90th$98Professionalmedian $107 · 10th–90th $71–$1910%10%10th90th$107$5.0$10.0$20.0$50.0$100.0$200.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $97.72 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $190.55
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $54.95 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $123.03 / $190.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $125.89 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $120.23 / $194.98
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $117.49 / $169.82