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Illinois 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 $191 · 10th–90th $95–$3470%10%10th90th$191Professionalmedian $182 · 10th–90th $105–$3980%5%10%10th90th$182$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
$93.33 / $169.82 / $309.03
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$181.97 / $263.03 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $169.82 / $389.05
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$114.82 / $199.53 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $165.96 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$128.82 / $169.82 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $275.42 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $158.49 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $302.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $213.80 / $436.52
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $190.55 / $223.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $173.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $162.18 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $194.98 / $323.59
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $97.72 / $323.59