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North Carolina 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 $178 · 10th–90th $115–$3240%10%10th90th$178Professionalmedian $182 · 10th–90th $112–$4070%5%10%10th90th$182$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
$123.03 / $173.78 / $323.59
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$48.98 / $218.78 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $173.78 / $398.11
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$123.03 / $194.98 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $251.19
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$131.83 / $173.78 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $218.78 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $316.23
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $177.83 / $309.03
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $275.42
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $407.38
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $218.78 / $363.08
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 / $158.49 / $263.03
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $97.72 / $323.59
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13