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New Jersey 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 $126 · 10th–90th $76–$3160%10%10th90th$126Professionalmedian $170 · 10th–90th $100–$3800%10%10th90th$170$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
$75.86 / $125.89 / $316.23
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $165.96 / $363.08
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$107.15 / $190.55 / $426.58
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $158.49 / $223.87
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$114.82 / $162.18 / $208.93
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $2,630.27 / $2,630.27
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $173.78 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $181.97 / $316.23
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $104.71 / $295.12
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $194.98 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $154.88 / $302.00
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $89.13 / $309.03