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Maine 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 $234 · 10th–90th $112–$6610%10%20%10th90th$234Professionalmedian $166 · 10th–90th $98–$3800%10%20%10th90th$166$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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 / $194.98 / $602.56
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$69.18 / $302.00 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $346.74
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$109.65 / $194.98 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $199.53 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $173.78 / $338.84
Community Health Options
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $257.04 / $338.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $239.88 / $436.52
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $144.54 / $16,218.10
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $147.91 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $213.80 / $354.81
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $204.17 / $323.59