Outpatient office consultation, straightforward complexity

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC OFFICE CONSULT LEVEL 2

Payers reporting CPT 99242

Payer pricing summary

Low

$38

Average

$183

Median

$178

High

$458

Payer rate distribution

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#
1	Blue Cross Blue Shield fee schedule · outpatient · +31 other terms	164	$203	$211	$118	56%	—	$0 – $904
2	UnitedHealthcare fee schedule · outpatient · +36 other terms	156	$76	$134	$93	69%	—	$1 – $443
3	Humana fee schedule · outpatient · +23 other terms	154	$103	$206	$716	348%	—	$28 – $8.3k
4	Aetna fee schedule · outpatient · +29 other terms	139	$76	$330	$1.0k	308%	—	$12 – $8.4k
5	Cigna fee schedule · outpatient · +30 other terms	77	$86	$190	$159	83%	—	$5 – $581
6	Anthem fee schedule · outpatient · +21 other terms	66	$73	$86	$85	99%	—	$48 – $771
7	Molina facility · case rate · outpatient · +20 other terms	38	$61	$82	$55	66%	—	$28 – $197
8	Kaiser fee schedule · outpatient · +17 other terms	33	$76	$99	$75	75%	—	$5 – $478
9	WellCare facility · fee schedule · outpatient · +15 other terms	31	$31	$49	$21	43%	—	$28 – $78
10	Medicaid fee schedule · outpatient · +10 other terms	26	$110	$119	$83	70%	—	$1 – $478
11	Bcbs Tx fee schedule · outpatient · +3 other terms	23	$277	$273	$87	32%	—	$81 – $467
12	Devoted fee schedule · outpatient · +11 other terms	22	$74	$75	$1	1%	—	$72 – $76
13	Tricare facility · fee schedule · outpatient · +15 other terms	22	$44	$1.5k	$8.2k	533%	—	$24 – $50k
14	Optum professional · fee schedule · outpatient · +16 other terms	21	$75	$60	$19	32%	—	$32 – $78
15	Caresource facility · case rate · outpatient · +10 other terms	20	$69	$81	$30	37%	—	$42 – $144
16	Medica fee schedule · outpatient · +19 other terms	19	$137	$154	$58	38%	—	$43 – $249
17	Medicare fee schedule · outpatient · +8 other terms	18	$76	$76	—	—	—	$76 – $76
18	Highmark facility · fee schedule · outpatient · +12 other terms	16	$77	$124	$101	81%	—	$17 – $375
19	Aetna Better Health fee schedule · outpatient · +11 other terms	15	$68	$65	$5	7%	—	$59 – $73
20	Ambetter facility · fee schedule · outpatient · +15 other terms	14	$130	$98	$33	34%	—	$0 – $130
21	Ucare professional · fee schedule · outpatient · +12 other terms	14	$79	$77	$6	8%	—	$55 – $82
22	Amerihealth Caritas fee schedule · both · +7 other terms	13	$67	$63	$7	11%	—	$49 – $67
23	Bcbs Nj fee schedule · outpatient · +4 other terms	13	$65	$73	$30	41%	—	$65 – $177
24	Wellmark fee schedule · both · +12 other terms	13	$78	$78	—	—	—	$78 – $78
25	Bcbs Mn fee schedule · outpatient · +6 other terms	12	$306	$208	$126	60%	—	$56 – $383

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