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Virginia 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 $158 · 10th–90th $117–$4170%20%10th90th$158Professionalmedian $155 · 10th–90th $115–$3090%20%10th90th$155$0.0$0.2$2.0$20.0$200.0$2.0K

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
$114.82 / $131.83 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $154.88 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $398.11
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $120.23 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $194.98 / $363.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $549.54
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $194.98 / $288.40
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $208.93 / $309.03
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $134.90 / $134.90
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $4,073.80
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $4,073.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $331.13