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Washington rates for HCPCS 99221

Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Facilitymedian $158 · 10th–90th $110–$2340%10%10th90th$158Professionalmedian $123 · 10th–90th $69–$2820%5%10%10th90th$123$20.0$100.0$500.0$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
$109.65 / $144.54 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $114.82 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $128.82 / $158.49
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $165.96 / $245.47
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $165.96 / $218.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $173.78 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $60.26
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $158.49 / $194.98
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $131.83 / $131.83
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $173.78 / $239.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $79.43 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $131.83 / $234.42
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $85.11 / $151.36