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Virginia 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 $89 · 10th–90th $59–$1550%10%20%10th90th$89Professionalmedian $83 · 10th–90th $46–$1410%10%10th90th$83$0.0$0.2$2.0$20.0$200.0$2.0K

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
$47.86 / $64.57 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $81.28 / $138.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $56.23 / $218.78
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $31.62 / $61.66
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
$61.66 / $91.20 / $147.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $151.36
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
$60.26 / $97.72 / $162.18
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $208.93
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $125.89
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $109.65 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $66.07 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $87.10 / $141.25