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Connecticut 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 $240 · 10th–90th $155–$3980%20%10th90th$240Professionalmedian $182 · 10th–90th $100–$4170%10%10th90th$182$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
$154.88 / $239.88 / $398.11
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$204.17 / $234.42 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $169.82 / $389.05
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$112.20 / $208.93 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $165.96 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $181.97 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $186.21 / $323.59
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $204.17 / $354.81
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $181.97 / $257.04
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $269.15 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $128.82 / $162.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $186.21 / $331.13
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $204.17 / $371.54