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South Dakota 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 $135 · 10th–90th $69–$3800%10%10th90th$135Professionalmedian $178 · 10th–90th $105–$3720%5%10%10th90th$178$20.0$50.0$100.0$200.0$500.0$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
$60.26 / $128.82 / $380.19
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $162.18 / $363.08
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$123.03 / $208.93 / $389.05
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $186.21 / $213.80
Avera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $208.93 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $245.47 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $165.96 / $295.12
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $281.84 / $1,047.13
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$208.93 / $302.00 / $446.68
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $257.04 / $323.59
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $251.19 / $363.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $323.59
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
$112.20 / $190.55 / $331.13
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $263.03 / $354.81
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $208.93 / $263.03