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Pennsylvania 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 $9 · 10th–90th $4–$1820%10%10th90th$9Professionalmedian $87 · 10th–90th $43–$1620%10%10th90th$87$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$3.72 / $8.51 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $87.10 / $162.18
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $107.15
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $158.49
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
$60.26 / $89.13 / $144.54
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $123.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $154.88
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $229.09
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.27 / $7.94 / $173.78
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $89.13 / $162.18
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $85.11 / $112.20
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $194.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $87.10 / $102.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $27.54 / $87.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $141.25