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Iowa 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 $98–$3160%10%10th90th$170Professionalmedian $191 · 10th–90th $102–$4370%10%10th90th$191$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
$100.00 / $199.53 / $302.00
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$25.12 / $97.72 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $177.83 / $436.52
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $213.80 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $213.80 / $380.19
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $213.80 / $416.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $309.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $257.04 / $1,047.13
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$245.47 / $389.05 / $512.86
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $269.15 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $323.59 / $426.58
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $363.08
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $218.78 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $190.55 / $338.84
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $165.96 / $263.03
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $190.55 / $239.88