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Washington rates for HCPCS 99226

Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.

Facilitymedian $162 · 10th–90th $71–$2450%10%10th90th$162Professionalmedian $158 · 10th–90th $85–$2400%10%10th90th$158$100.0$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
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $229.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $158.49 / $245.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $169.82 / $245.47
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $194.98 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $134.90 / $213.80