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Maryland 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 $63 · 10th–90th $54–$870%20%40%10th90th$63Professionalmedian $83 · 10th–90th $45–$1410%5%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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $63.10 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $83.18 / $144.54
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $31.62 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $87.10 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $66.07 / $87.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $138.04
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $112.20