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North Carolina 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 $107 · 10th–90th $65–$2000%5%10%10th90th$107Professionalmedian $112 · 10th–90th $59–$1820%5%10%10th90th$112$5.0$20.0$100.0$500.0$2.0K

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
$66.07 / $128.82 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $95.50 / $177.83
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $85.11 / $144.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $134.90 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $169.82
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $109.65 / $162.18
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $181.97
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $100.00 / $223.87
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $91.20 / $109.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $85.11 / $138.04
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54