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Pennsylvania 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 $21 · 10th–90th $11–$4270%10%10th90th$21Professionalmedian $204 · 10th–90th $135–$4680%20%10th90th$204$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$10.72 / $21.38 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $199.53 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $257.04
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $229.09 / $398.11
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
$177.83 / $239.88 / $371.54
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $398.11
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $147.91 / $426.58
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $288.40 / $645.65
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.72 / $20.89 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $204.17 / $389.05
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $234.42 / $281.84
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $478.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $208.93 / $251.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $81.28 / $251.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $223.87 / $371.54