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Virginia 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 $174–$3800%20%10th90th$240Professionalmedian $200 · 10th–90th $141–$3470%20%10th90th$200$0.0$0.2$2.0$20.0$200.0$2.0K

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
$134.90 / $177.83 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $194.98 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $158.49 / $549.54
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $114.82 / $223.87
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 / $245.47 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $229.09 / $371.54
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $269.15 / $331.13
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $389.05
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $489.78
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $229.09 / $354.81
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $269.15 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $177.83 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $229.09 / $380.19