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Ohio 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 $120 · 10th–90th $48–$1820%20%10th90th$120Professionalmedian $182 · 10th–90th $105–$4170%10%20%10th90th$182$1.0$5.0$20.0$100.0$500.0$2.0K

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
$48.98 / $120.23 / $181.97
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$47.86 / $79.43 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $173.78 / $398.11
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$117.49 / $204.17 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $158.49 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$125.89 / $165.96 / $223.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $147.91 / $234.42
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $177.83 / $257.04
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $208.93
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $173.78 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $144.54 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $169.82 / $302.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $144.54 / $204.17
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $190.55 / $281.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $102.33
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $186.21 / $281.84
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $177.83 / $239.88
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
$100.00 / $158.49 / $288.40
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $97.72 / $263.03