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South 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 $98 · 10th–90th $62–$1620%5%10%10th90th$98Professionalmedian $83 · 10th–90th $48–$1450%5%10%10th90th$83$5.0$20.0$100.0$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
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $83.18 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $144.54 / $154.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $102.33
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 / $91.20 / $138.04
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $109.65 / $138.04
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $97.72 / $162.18
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $54.95 / $87.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $81.28 / $120.23