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Virginia 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 $166 · 10th–90th $107–$2630%10%20%10th90th$166Professionalmedian $170 · 10th–90th $107–$3800%10%20%10th90th$170$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
$50.12 / $141.25 / $223.87
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$26.30 / $26.30 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $363.08
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$112.20 / $194.98 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $190.55 / $316.23
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $199.53 / $295.12
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $177.83 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $275.42
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $302.00
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $245.47
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $186.21 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $120.23 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $158.49 / $281.84
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $162.18 / $323.59