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New York rates for HCPCS 99212

Office or other outpatient visit for the evaluation and management of an 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, 10 minutes must be met or exceeded.

Facilitymedian $85 · 10th–90th $32$4270%10%10th90th$85Professionalmedian $54 · 10th–90th $29$1170%10%10th90th$54$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$27.54 / $61.66 / $302.00
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$77.62 / $234.42 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $53.70 / $117.49
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$32.36 / $58.88 / $123.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $50.12 / $66.07
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$34.67 / $54.95 / $63.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $363.08 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $36.31 / $72.44
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $128.82
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $97.72 / $245.47
Cigna
Facility/Professional
Facility
Modifier
22
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$33.88 / $33.88 / $33.88
Cigna
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $54.95 / $114.82
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $41.69
Emblem Health
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$0.10 / $0.10 / $0.10
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $42.66 / $89.13
Emblem Health
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$69.18 / $91.20 / $177.83
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $36.31 / $63.10
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $56.23 / $114.82
Fidelis
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $38.02 / $85.11
Fidelis
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$26.92 / $53.70 / $74.13
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $144.54 / $245.47
Highmark BCBS
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$199.53 / $199.53 / $245.47
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $57.54 / $117.49
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$46.77 / $48.98 / $75.86
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$56.23 / $56.23 / $56.23
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $63.10 / $125.89
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $56.23 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $46.77 / $58.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $50.12 / $117.49
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$54.95 / $79.43 / $100.00
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $36.31 / $63.10
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $60.26 / $97.72