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North Carolina 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 $257 · 10th–90th $182–$4470%10%10th90th$257Professionalmedian $257 · 10th–90th $162–$5130%5%10%10th90th$257$10.0$20.0$50.0$100.0$200.0$500.0$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
$181.97 / $251.19 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $208.93 / $501.19
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $302.00 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $363.08 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $257.04 / $426.58
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $269.15 / $398.11
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $257.04 / $389.05
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $173.78 / $549.54
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $229.09 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $251.19 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $363.08
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96