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New Jersey 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 $81 · 10th–90th $52–$1000%10%20%10th90th$81Professionalmedian $87 · 10th–90th $48–$1480%5%10%10th90th$87$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
$52.48 / $81.28 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $83.18 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $100.00 / $162.18
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $34.67
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $138.04
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $102.33 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $79.43 / $147.91