go back

Texas 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 $240 · 10th–90th $138–$4370%10%10th90th$240Professionalmedian $195 · 10th–90th $135–$3160%10%10th90th$195$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
$117.49 / $138.04 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $194.98 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $208.93 / $323.59
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $489.78 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $186.21 / $234.42
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $229.09 / $316.23
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
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
$173.78 / $245.47 / $398.11
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
$245.47 / $870.96 / $1,348.96
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $245.47 / $407.38
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $194.98
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $239.88 / $436.52
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $245.47 / $407.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $245.47 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $208.93 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $338.84
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $213.80 / $229.09