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Maine 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 $550 · 10th–90th $550–$5500%50%100%$550Professionalmedian $158 · 10th–90th $115–$2820%10%10th90th$158$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $154.88 / $269.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $162.18 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $213.80 / $309.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $354.81
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $158.49 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $331.13