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Washington rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $275 · 10th–90th $174–$4680%10%10th90th$275Professionalmedian $209 · 10th–90th $145–$6170%10%10th90th$209$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$218.78 / $371.54 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $204.17 / $676.08
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $218.78 / $398.11
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $549.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $263.03 / $457.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $257.04 / $446.68
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $302.00
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $416.87 / $426.58
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $371.54 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $288.40 / $467.74
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $234.42 / $371.54