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Washington 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 $66–$1700%10%10th90th$102Professionalmedian $93 · 10th–90th $50–$1950%5%10th90th$93$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
$87.10 / $125.89 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $91.20 / $204.17
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $120.23
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $64.57
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
$66.07 / $104.71 / $199.53
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $165.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $95.50 / $162.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $95.50
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $147.91 / $173.78
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $151.36 / $223.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $64.57
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $57.54 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $109.65 / $177.83
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $114.82