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North Carolina 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 $224 · 10th–90th $158–$4680%10%20%10th90th$224Professionalmedian $191 · 10th–90th $120–$4680%5%10%10th90th$191$10.0$50.0$200.0$1.0K$5.0K

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
$158.49 / $239.88 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $177.83 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $208.93 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $275.42 / $398.11
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
$147.91 / $204.17 / $338.84
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $204.17 / $316.23
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $416.87
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $165.96 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $186.21 / $331.13
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00