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New York 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 $200 · 10th–90th $123–$2880%50%10th90th$200Professionalmedian $182 · 10th–90th $120–$4790%20%10th90th$182$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
$134.90 / $199.53 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $181.97 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $134.90 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $141.25 / $331.13
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $234.42 / $645.65
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $154.88 / $354.81
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $190.55 / $288.40
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $213.80 / $316.23
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $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 / $138.04 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $186.21 / $323.59
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $138.04 / $489.78
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $208.93 / $426.58