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Vermont 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.

Professionalmedian $155 · 10th–90th $112–$2630%20%10th90th$155$0.1$0.5$2.0$10.0$50.0$200.0

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
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $151.36 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $218.78 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $213.80 / $338.84
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.05 / $0.05 / $0.05
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $234.42 / $346.74