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Pennsylvania 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 $7 · 10th–90th $4–$1380%20%10th90th$7Professionalmedian $105 · 10th–90th $49–$1780%10%20%10th90th$105$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$3.89 / $7.24 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $107.15 / $177.83
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $85.11 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $128.82
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $114.82 / $144.54
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $117.49 / $162.18
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.89 / $7.24 / $107.15
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $112.20 / $223.87
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $91.20
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $131.83 / $177.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $75.86 / $83.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $75.86 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $147.91