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Pennsylvania rates for HCPCS 99253

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

Facilitymedian $42 · 10th–90th $6–$1950%20%10th90th$42Professionalmedian $126 · 10th–90th $68–$2630%10%20%10th90th$126$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$6.03 / $41.69 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $263.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72
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
$102.33 / $186.21 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $194.98
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
$114.82 / $162.18 / $208.93
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $165.96 / $239.88
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $109.65
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.03 / $11.75 / $107.15
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $125.89 / $251.19
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $104.71 / $141.25
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $204.17 / $281.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $42.66 / $128.82
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $45.71 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $229.09