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Ohio 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 $60 · 10th–90th $44–$980%20%10th90th$60Professionalmedian $79 · 10th–90th $46–$1480%10%10th90th$79$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
$39.81 / $53.70 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $81.28 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $58.88 / $102.33
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $60.26 / $85.11
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $75.86 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $89.13 / $147.91
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $302.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $147.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $48.98 / $74.13
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $87.10 / $154.88
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $81.28 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $91.20 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $138.04