go back

Maine 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 $209 · 10th–90th $209–$2450%50%90th$209Professionalmedian $105 · 10th–90th $54–$1580%10%10th90th$105$5.0$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
$208.93 / $208.93 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $104.71 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $154.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $104.71 / $181.97
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $154.88