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Washington 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 $191 · 10th–90th $120–$3390%10%10th90th$191Professionalmedian $191 · 10th–90th $107–$4900%5%10%10th90th$191$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
$147.91 / $190.55 / $309.03
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$39.81 / $144.54 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $181.97 / $467.74
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $208.93 / $549.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $331.13
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$144.54 / $199.53 / $331.13
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $251.19 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $204.17 / $407.38
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $338.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $338.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $83.18 / $181.97
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $309.03 / $331.13
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $234.42 / $407.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $251.19 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $100.00 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $204.17 / $346.74
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$89.13 / $158.49 / $323.59
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $181.97 / $257.04