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Washington 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.

Facilitymedian $245 · 10th–90th $166–$3470%10%10th90th$245Professionalmedian $186 · 10th–90th $123–$5620%10%10th90th$186$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
$165.96 / $239.88 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $181.97 / $575.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $218.78 / $257.04
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $204.17 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $275.42 / $426.58
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $281.84 / $363.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $281.84 / $380.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $131.83 / $263.03
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $269.15 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $204.17 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $131.83 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $223.87 / $389.05
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $288.40