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Hospital Consultation, Lower Complexity

Massachusetts rates for HCPCS 99252

A specialist's opinion on a hospital patient, requested by the doctor already caring for them. The consultant takes a history, examines the patient, reviews the records, and writes back with advice. This is one of the shorter consultations of its kind, for a problem that is fairly limited in complexity.

Rates data updated July 2026.

How much does Hospital Consultation, Lower Complexity cost?

$112

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $107 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$112$83.18 to $145
FacilityA hospital or hospital-owned outpatient department$107$100 to $126

How much rates vary

Facilitymedian $107 · 10th to 90th $72 to $132Professionalmedian $112 · 10th to 90th $68 to $195
$50$100$200$500facility $107professional $112

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$109.65
Typical High
$194.98
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$549.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$134.90
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$117.49
Typical High
$165.96
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$97.72
Typical High
$162.18
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$79.43
Typical High
$114.82
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$181.97
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$120.23
Typical High
$199.53

Where Massachusetts sits

The same service costs 2.3 times more in South Dakota than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Massachusetts· 21st of 51

$112

SD $158DC $67.61

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.