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Michigan 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 $138 · 10th–90th $87–$1860%10%20%10th90th$138Professionalmedian $182 · 10th–90th $107–$4370%5%10%10th90th$182$10.0$20.0$50.0$100.0$200.0$500.0$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
$100.00 / $131.83 / $177.83
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$50.12 / $50.12 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $169.82 / $416.87
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $204.17 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $158.49 / $223.87
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$125.89 / $169.82 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $194.98 / $204.17
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $288.40
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $169.82 / $229.09
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $208.93 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $162.18 / $338.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $138.04 / $181.97
Health Alliance Plan
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$50.12 / $50.12 / $416.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $346.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$117.49 / $204.17 / $457.09
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $147.91
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $134.90 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $162.18 / $323.59
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $100.00 / $354.81