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California 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 $83 · 10th–90th $56–$1660%20%10th90th$83Professionalmedian $105 · 10th–90th $54–$2950%10%10th90th$105$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
$61.66 / $104.71 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $104.71 / $295.12
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $131.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $64.57 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $104.71 / $169.82
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $89.13
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $112.20 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $165.96
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $46.77 / $70.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $257.04 / $478.63
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $52.48 / $107.15
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $104.71 / $194.98
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $95.50 / $162.18
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $104.71 / $186.21
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $58.88 / $87.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $162.18