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New York 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 $85 · 10th–90th $50–$1380%20%10th90th$85Professionalmedian $85 · 10th–90th $46–$1700%10%10th90th$85$0.0$0.1$0.5$2.0$10.0$50.0$200.0

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
$51.29 / $87.10 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $91.20 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $61.66 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $67.61 / $128.82
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $123.03
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 / $104.71 / $199.53
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $38.02 / $70.79
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $131.83
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $56.23
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $81.28 / $173.78
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $0.05
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $91.20 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $69.18 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $79.43 / $208.93
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $57.54 / $147.91
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $81.28 / $169.82