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New York rates for HCPCS 99243

Office or other outpatient consultation for a new or 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, 30 minutes must be met or exceeded.

Facilitymedian $100 · 10th–90th $71–$1950%20%10th90th$100Professionalmedian $115 · 10th–90th $72–$2510%20%10th90th$115$0.0$0.2$2.0$20.0$200.0

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
$70.79 / $102.33 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $114.82 / $245.47
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $109.65 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $93.33 / $194.98
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $281.84
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $67.61 / $104.71
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $199.53
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $112.20 / $239.88
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $0.05
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $128.82 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $309.03
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $81.28 / $208.93
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $114.82 / $239.88