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Washington 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 $145 · 10th–90th $93–$2450%10%10th90th$145Professionalmedian $115 · 10th–90th $72–$2750%10%10th90th$115$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $194.98 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $112.20 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $151.36 / $234.42
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $97.72
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
$93.33 / $154.88 / $288.40
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $138.04 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $134.90 / $234.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $79.43 / $154.88
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $223.87 / $234.42
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $199.53 / $309.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $97.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $154.88 / $251.19
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $181.97