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California 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 $120$3240%20%10th90th$170Professionalmedian $195 · 10th–90th $123$5370%10%20%10th90th$195$1.0$5.0$20.0$100.0$500.0$2.0K

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
$123.03 / $186.21 / $371.54
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$162.18 / $354.81 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $190.55 / $524.81
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$125.89 / $199.53 / $549.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $257.04
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$134.90 / $173.78 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $302.00
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $89.13
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $213.80 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $323.59
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $128.82 / $257.04
HealthNet
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $295.12 / $616.60
HealthNet
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$194.98 / $194.98 / $199.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $309.03
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $75.86 / $239.88
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $190.55 / $269.15
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $173.78 / $275.42
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $186.21 / $363.08
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $331.13 / $426.58
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $104.71 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $173.78 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $295.12
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $131.83 / $257.04