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Massachusetts 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 $162 · 10th–90th $93–$3160%10%10th90th$162Professionalmedian $195 · 10th–90th $107–$4570%5%10%10th90th$195$10.0$50.0$200.0$1.0K

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
$125.89 / $181.97 / $251.19
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $181.97 / $446.68
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $208.93 / $512.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $446.68 / $831.76
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $194.98 / $512.86
AllWays Health Partners
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $107.15 / $208.93
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $199.53 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $263.03 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $354.81
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $100.00 / $190.55
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $158.49 / $295.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $245.47 / $446.68
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $199.53 / $245.47
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $269.15 / $537.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $446.68 / $831.76
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $194.98 / $512.86
Mass General Brigham
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $107.15 / $208.93
Tufts
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $100.00 / $114.82
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $158.49 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $131.83 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $204.17 / $436.52
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $95.50 / $371.54