search again

Nationwide rates for HCPCS 99204

Office or other outpatient visit for the evaluation and management of a new 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, 45 minutes must be met or exceeded.

Facilitymedian $170 · 10th–90th $102$3630%10%20%10th90th$170Professionalmedian $182 · 10th–90th $107$4270%10%20%10th90th$182$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$95.50 / $154.88 / $354.81
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$61.66 / $288.40 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $173.78 / $398.11
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$117.49 / $199.53 / $457.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $186.21
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $151.36 / $269.15
BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $131.83 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $165.96 / $354.81
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $131.83 / $309.03