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Office Visit, New Patient (Moderate Complexity)

Nationwide rates for HCPCS 99204

An initial appointment with a doctor or provider the patient has not seen before, involving a moderate level of medical decision-making, such as reviewing several health concerns or evaluating a condition that needs a closer look. First visits like this typically involve more time than a follow-up because the provider is building a full picture of the patient's health history for the first time. It reflects a meaningful step up in complexity from the most basic new-patient visit.

Rates data updated July 2026.

Facilitymedian $166 · 10th–90th $102$3550%10%20%10th90th$166Professionalmedian $178 · 10th–90th $105$4270%10%20%10th90th$178$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
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$144.54
Typical High
$363.08
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$52.48
Median
$281.84
Typical High
$575.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$398.11
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$194.98
Typical High
$489.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$165.96
Typical High
$186.21
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$151.36
Typical High
$269.15
BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$165.96
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$177.83
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$169.82
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$131.83
Typical High
$309.03