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New Jersey rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $135 · 10th–90th $102–$2240%20%10th90th$135Professionalmedian $166 · 10th–90th $110–$3800%10%10th90th$166$10.0$20.0$50.0$100.0$200.0$500.0

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
$102.33 / $134.90 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $218.78 / $363.08
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $190.55 / $288.40
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $186.21 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $109.65 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $162.18 / $302.00