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New Jersey rates for HCPCS 99245

Office or other outpatient consultation for a new or established 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, 55 minutes must be met or exceeded.

Facilitymedian $224 · 10th–90th $100–$1,5490%5%10%10th90th$224Professionalmedian $204 · 10th–90th $141–$3980%10%10th90th$204$10.0$50.0$200.0$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
$100.00 / $223.87 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $199.53 / $398.11
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $223.87 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $416.87
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $134.90 / $389.05
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $251.19 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $208.93 / $389.05