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Nationwide rates for HCPCS 99242

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $89 · 10th–90th $52$1660%20%10th90th$89Professionalmedian $87 · 10th–90th $48$1580%20%10th90th$87$0.0$0.2$2.0$20.0$200.0$2.0K$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
$43.65 / $79.43 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $85.11 / $151.36
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $64.57 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $70.79 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $93.33 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $79.43 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $87.10 / $165.96