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Wisconsin 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 $83 · 10th–90th $54–$1550%10%20%10th90th$83Professionalmedian $89 · 10th–90th $48–$2140%10%10th90th$89$1.0$5.0$20.0$100.0$500.0$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 / $77.62 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $79.43 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $89.13 / $173.78
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $67.61 / $97.72
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $89.13 / $162.18
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 / $117.49 / $218.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $154.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $141.25 / $204.17
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $158.49
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $158.49 / $537.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $51.29 / $100.00
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $151.36 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $141.25 / $223.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $416.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $141.25 / $549.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $162.18
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $70.79 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $165.96 / $288.40