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California 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 $138–$4370%20%10th90th$174Professionalmedian $191 · 10th–90th $132–$5890%10%20%10th90th$191$0.0$0.2$2.0$20.0$200.0

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
$138.04 / $151.36 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $190.55 / $588.84
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $186.21 / $295.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $173.78 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $218.78 / $457.09
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $213.80 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $208.93 / $389.05
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $64.57 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $602.56 / $676.08
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $194.98 / $691.83
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $323.59
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $208.93 / $416.87
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $91.20 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $446.68