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Pennsylvania 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 $17 · 10th–90th $9–$2690%20%10th90th$17Professionalmedian $174 · 10th–90th $89–$4680%10%20%10th90th$174$10.0$50.0$200.0$1.0K$5.0K$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.71 / $16.98 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $173.78 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $134.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $194.98 / $275.42
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $288.40
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $229.09 / $346.74
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.71 / $16.22 / $158.49
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $165.96 / $338.84
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $147.91 / $204.17
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $302.00 / $398.11
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $181.97
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $177.83 / $331.13