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Vermont 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 $102 · 10th–90th $78–$1150%50%10th90th$102Professionalmedian $89 · 10th–90th $45–$1380%10%20%10th90th$89$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $85.11 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $158.49 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $100.00 / $141.25
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $109.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $97.72 / $186.21