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Hospital Consultation, Lower Complexity

North Carolina 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?

$123

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $123 from a physician practice, and about $123 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$123$87.10 to $151
FacilityA hospital or hospital-owned outpatient department$123$72.44 to $170

How much rates vary

Facilitymedian $123 · 10th to 90th $72 to $214Professionalmedian $123 · 10th to 90th $66 to $186
$10$20$50$100$200facility $123professional $123

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
$123.03
Typical High
$213.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$123.03
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$93.33
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$97.72
Typical High
$158.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Medcost
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$123.03
Typical High
$181.97
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$181.97
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$83.18
Typical High
$151.36
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54

Where North Carolina 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.

North Carolina· 9th of 51

$123

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.