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Iowa 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 $110 · 10th–90th $62–$1700%20%10th90th$110Professionalmedian $85 · 10th–90th $47–$2450%10%10th90th$85$1.0$5.0$20.0$100.0$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
$91.20 / $131.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $83.18 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $85.11 / $151.36
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $117.49 / $302.00
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $169.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $131.83 / $537.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $141.25 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $141.25 / $288.40
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $87.10 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $85.11 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $100.00 / $181.97
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $81.28 / $107.15