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New Jersey rates for HCPCS 99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $148 · 10th–90th $40–$3800%10%10th90th$148Professionalmedian $83 · 10th–90th $48–$1820%10%20%10th90th$83$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$38.02 / $128.82 / $354.81
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$93.33 / $302.00 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $81.28 / $177.83
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$48.98 / $87.10 / $190.55
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$257.04 / $269.15 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $83.18 / $117.49
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$63.10 / $87.10 / $112.20
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $114.82 / $5,888.44
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $72.44 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $169.82 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $83.18 / $151.36
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $40.74 / $131.83
Emblem Health
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$40.74 / $131.83 / $204.17
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $87.10 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $69.18 / $144.54
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$75.86 / $95.50 / $138.04