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Delaware 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 $4 · 10th–90th $3–$980%20%10th90th$4Professionalmedian $83 · 10th–90th $43–$1410%5%10%10th90th$83$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
$3.39 / $4.47 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $83.18 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $89.13 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $79.43 / $125.89