go back

Indiana 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 $117 · 10th–90th $81–$2880%10%20%10th90th$117Professionalmedian $174 · 10th–90th $102–$3630%5%10%10th90th$174$1.0$5.0$20.0$100.0$500.0

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
$81.28 / $107.15 / $288.40
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$31.62 / $102.33 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $165.96 / $354.81
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$112.20 / $194.98 / $380.19
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$131.83 / $169.82 / $229.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $169.82 / $245.47
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $158.49 / $194.98
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $186.21 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $114.82 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $162.18 / $275.42
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
$104.71 / $151.36 / $263.03
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $158.49 / $309.03