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Utah 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 $282 · 10th–90th $162–$3470%20%40%10th90th$282Professionalmedian $186 · 10th–90th $107–$5250%5%10%10th90th$186$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
$144.54 / $269.15 / $346.74
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$208.93 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $181.97 / $501.19
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$112.20 / $194.98 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $190.55 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $309.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $190.55 / $269.15
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $199.53 / $467.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $199.53 / $389.05
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
$109.65 / $165.96 / $275.42
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $144.54 / $208.93