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Oregon rates for HCPCS 99235

Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, 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, 70 minutes must be met or exceeded.

Facilitymedian $302 · 10th–90th $182–$3720%10%20%10th90th$302Professionalmedian $302 · 10th–90th $229–$3720%20%10th90th$302$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $302.00 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $302.00 / $371.54
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $245.47 / $380.19
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $309.03 / $323.59
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $245.47 / $389.05