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Georgia 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 $195 · 10th–90th $126–$5370%10%20%10th90th$195Professionalmedian $170 · 10th–90th $107–$3630%10%20%10th90th$170$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
$117.49 / $173.78 / $524.81
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$251.19 / $478.63 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $354.81
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$112.20 / $181.97 / $389.05
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $173.78 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$138.04 / $181.97 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $169.82 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $181.97 / $257.04
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $199.53 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $295.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $199.53 / $346.74
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $257.04 / $588.84
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $218.78 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $131.83 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $165.96 / $288.40
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $181.97 / $323.59