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New York rates for HCPCS 99253

Inpatient or observation 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, 45 minutes must be met or exceeded.

Facilitymedian $138 · 10th–90th $85–$2340%50%10th90th$138Professionalmedian $135 · 10th–90th $85–$2880%20%40%10th90th$135$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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 / $138.04 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $138.04 / $295.12
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $97.72 / $229.09
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $165.96 / $446.68
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $128.82 / $346.74
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $138.04 / $208.93
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $147.91 / $213.80
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $50,118.72 / $75,857.76
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
$66.07 / $104.71 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $134.90 / $239.88
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $95.50 / $338.84
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $141.25 / $295.12