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Vermont 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 $162 · 10th–90th $120–$3720%10%20%10th90th$162Professionalmedian $174 · 10th–90th $105–$3470%5%10%10th90th$174$50.0$100.0$200.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $162.18 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $162.18 / $331.13
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$128.82 / $204.17 / $354.81
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $245.47 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $288.40
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $213.80 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $120.23 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $363.08
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $85.11 / $257.04