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Nationwide rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $219 · 10th–90th $138$4470%10%20%10th90th$219Professionalmedian $240 · 10th–90th $145$5890%10%10th90th$240$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$128.82 / $204.17 / $446.68
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$144.54 / $363.08 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $223.87 / $562.34
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $309.03 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $229.09 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $169.82 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $213.80 / $467.74
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $89.13 / $426.58