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South 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 $151 · 10th–90th $105–$2630%10%10th90th$151Professionalmedian $162 · 10th–90th $98–$3550%10%10th90th$162$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
$95.50 / $128.82 / $218.78
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $158.49 / $354.81
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$104.71 / $186.21 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $245.47
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$131.83 / $169.82 / $257.04
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $223.87 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $104.71 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $162.18 / $281.84
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $177.83 / $204.17
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $169.82 / $275.42
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $144.54 / $229.09
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $162.18 / $371.54