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California rates for HCPCS 99252

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.

Facilitymedian $78 · 10th–90th $62–$1950%20%40%10th90th$78Professionalmedian $123 · 10th–90th $62–$2630%10%20%10th90th$123$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
$64.57 / $123.03 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $123.03 / $263.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $104.71 / $208.93
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $104.71 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $95.50 / $186.21
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $32.36 / $38.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $229.09 / $398.11
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $87.10 / $478.63
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $104.71 / $177.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $194.98
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $45.71 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $213.80