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Hospital Consultation, Moderate Complexity

New York rates for HCPCS 99254

This describes a visit where one physician asks another physician, usually a specialist, to evaluate a hospitalized patient and give an opinion or recommendation on a moderately complex medical problem. The consulting physician reviews the case, examines the patient, and documents findings and recommendations back to the physician who requested the opinion.

Rates data updated July 2026.

Facilitymedian $170 · 10th–90th $117$2340%50%10th90th$170Professionalmedian $178 · 10th–90th $117$5010%20%10th90th$178$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
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$169.82
Typical High
$229.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$134.90
Typical High
$194.98
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$331.13
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$234.42
Typical High
$562.34
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$154.88
Typical High
$354.81
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$190.55
Typical High
$288.40
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$213.80
Typical High
$316.23
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.03
Median
$0.05
Typical High
$407.38
Optum
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$138.04
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$177.83
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$186.21
Typical High
$323.59
Univera
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$138.04
Typical High
$489.78
Univera
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$208.93
Typical High
$426.58