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California 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 $151–$4370%20%10th90th$219Professionalmedian $263 · 10th–90th $162–$7240%10%10th90th$263$1.0$5.0$20.0$100.0$500.0$2.0K$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
$134.90 / $229.09 / $549.54
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$75.86 / $165.96 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $263.03 / $707.95
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $295.12 / $741.31
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $229.09 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $229.09 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $218.78 / $389.05
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $302.00 / $489.78
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $245.47 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $426.58
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $177.83 / $338.84
HealthNet
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $363.08 / $831.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $245.47 / $398.11
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $478.63 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $112.20 / $316.23
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $239.88 / $354.81
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $223.87 / $363.08
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $239.88 / $489.78
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $537.03
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $144.54 / $263.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $218.78 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $389.05
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $85.11 / $251.19