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Colorado 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 $7 · 10th–90th $5–$1350%10%10th90th$7Professionalmedian $83 · 10th–90th $45–$1450%10%20%10th90th$83$0.1$0.5$2.0$10.0$50.0$200.0

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
$4.57 / $7.41 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $83.18 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $72.44 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $147.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $204.17
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $77.62 / $107.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.09 / $100.00 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $158.49