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Nationwide rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $174 · 10th–90th $115$3980%20%40%10th90th$174Professionalmedian $174 · 10th–90th $115$4570%20%10th90th$174$0.0$0.2$2.0$20.0$200.0$2.0K$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
$107.15 / $154.88 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $457.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $173.78 / $436.52
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $204.17 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $131.83 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $190.55 / $371.54