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Ohio 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 $132 · 10th–90th $98–$2400%10%20%10th90th$132Professionalmedian $158 · 10th–90th $112–$3090%10%10th90th$158$2.0$10.0$50.0$200.0$1.0K

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
$97.72 / $131.83 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $158.49 / $331.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $154.88 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $223.87
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $158.49 / $199.53
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $177.83 / $309.03
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 / $181.97 / $275.42
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $114.82 / $165.96
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $138.04 / $190.55
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $173.78 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $173.78 / $275.42