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Georgia 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 $87 · 10th–90th $56–$1320%10%10th90th$87Professionalmedian $89 · 10th–90th $50–$1480%5%10%10th90th$89$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
$56.23 / $100.00 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $89.13 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $72.44 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $83.18 / $151.36
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $97.72
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $89.13 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $158.49
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $144.54 / $218.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $89.13 / $141.25