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New Jersey rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $269 · 10th–90th $120–$1,2020%10%10th90th$269Professionalmedian $229 · 10th–90th $138–$5010%5%10%10th90th$229$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$117.49 / $251.19 / $933.25
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$660.69 / $660.69 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $213.80 / $478.63
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $281.84 / $602.56
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $208.93 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $223.87 / $263.03
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $223.87 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $186.21 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $234.42 / $407.38
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $112.20 / $398.11
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $245.47 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $199.53 / $380.19
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $213.80 / $338.84