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Ohio 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 $85 · 10th–90th $65–$1380%20%10th90th$85Professionalmedian $110 · 10th–90th $71–$2090%20%10th90th$110$0.0$0.1$0.5$2.0$10.0$50.0$200.0

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
$64.57 / $81.28 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $112.20 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $158.49
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $173.78
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $95.50 / $138.04
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $114.82 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $125.89 / $213.80
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $398.11
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $67.61 / $102.33
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $138.04 / $245.47
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $125.89 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $120.23 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $120.23 / $213.80