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Utah 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 $112 · 10th–90th $98–$1320%20%10th90th$112Professionalmedian $115 · 10th–90th $72–$3550%10%10th90th$115$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $112.20 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $128.82 / $208.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $147.91
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $141.25 / $467.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $138.04 / $234.42
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
$87.10 / $123.03 / $194.98