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Pennsylvania 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 $12 · 10th–90th $6–$2400%10%10th90th$12Professionalmedian $112 · 10th–90th $65–$2290%20%10th90th$112$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$5.25 / $11.75 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $112.20 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $107.15 / $125.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $199.53 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $125.89 / $194.98
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $194.98
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $114.82 / $229.09
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $346.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $10.96 / $229.09
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $114.82 / $204.17
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $128.82 / $154.88
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $218.78
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $147.91 / $269.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $52.48 / $134.90
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $51.29 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $120.23 / $199.53