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Utah 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 $145 · 10th–90th $123–$1700%20%10th90th$145Professionalmedian $158 · 10th–90th $112–$4790%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $141.25 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $154.88 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $234.42 / $389.05
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $263.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $190.55 / $251.19
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $199.53 / $724.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $190.55 / $288.40