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Virginia 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 $126 · 10th–90th $87–$2040%20%10th90th$126Professionalmedian $107 · 10th–90th $71–$1820%20%10th90th$107$0.0$0.2$2.0$20.0$200.0$2.0K

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
$67.61 / $97.72 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $173.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $87.10 / $295.12
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $56.23 / $107.15
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 / $128.82 / $204.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $125.89 / $213.80
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $181.97
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $134.90 / $208.93
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $275.42
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $114.82 / $177.83
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $147.91 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $120.23 / $204.17