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Montana 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 $224 · 10th–90th $129–$3020%10%10th90th$224Professionalmedian $191 · 10th–90th $110–$4370%5%10%10th90th$191$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
$47.86 / $147.91 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $181.97 / $416.87
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$117.49 / $199.53 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $223.87 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $208.93 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $354.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $251.19 / $295.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $251.19 / $295.12
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $316.23
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $251.19 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $208.93 / $288.40
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $97.72 / $263.03