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California rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $219 · 10th–90th $162–$3890%20%10th90th$219Professionalmedian $229 · 10th–90th $155–$7410%10%20%10th90th$229$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
$162.18 / $204.17 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $223.87 / $741.31
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $177.83 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $257.04 / $416.87
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $89.13
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $275.42 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $263.03 / $436.52
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $616.60 / $977.24
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $1,348.96 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $112.20 / $302.00
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $331.13
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $251.19 / $371.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $269.15 / $512.86
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $213.80 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $218.78 / $407.38