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Utah 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 $100 · 10th–90th $71–$1320%10%20%10th90th$100Professionalmedian $91 · 10th–90th $48–$2630%5%10th90th$91$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
$70.79 / $100.00 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $91.20 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $91.20 / $147.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $107.15
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $93.33 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $91.20 / $177.83
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
$61.66 / $87.10 / $141.25