go back

Ohio 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 $178 · 10th–90th $135–$2690%20%10th90th$178Professionalmedian $200 · 10th–90th $138–$3890%20%10th90th$200$0.0$0.2$2.0$20.0$200.0

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
$131.83 / $169.82 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $199.53 / $407.38
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $316.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $288.40
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $323.59
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $194.98 / $281.84
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $213.80 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $239.88 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $234.42 / $407.38
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $239.88 / $407.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $131.83 / $194.98
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $223.87 / $426.58
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $239.88 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $218.78 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $380.19