go back

Massachusetts 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 $229 · 10th–90th $123–$3390%10%10th90th$229Professionalmedian $214 · 10th–90th $145–$5500%10%10th90th$214$10.0$50.0$200.0$1.0K

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
$186.21 / $245.47 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $588.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $1,148.15 / $1,148.15
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $257.04 / $457.09
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $158.49 / $281.84
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $213.80 / $331.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $338.84 / $537.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $1,148.15 / $1,148.15
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $263.03 / $549.54