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Office Visit, New Patient (Moderate Complexity)

Arizona 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 $170 · 10th–90th $102$1,5140%5%10%10th90th$170Professionalmedian $182 · 10th–90th $107$4570%10%10th90th$182$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$95.50
Median
$275.42
Typical High
$1,548.82
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$501.19
Median
$1,513.56
Typical High
$1,621.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$457.09
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$190.55
Typical High
$524.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$165.96
Typical High
$218.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$35.48
Typical High
$50.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$123.03
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$114.82
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$162.18
Typical High
$309.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$151.36
Typical High
$251.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$199.53
Typical High
$1,047.13
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$177.83
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$112.20
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$302.00
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$165.96
Typical High
$309.03