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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.

How much does Office Visit, New Patient (Moderate Complexity) cost?

$178

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $178 for this service. The price depends on where it is billed: about $178 from a physician practice, and about $162 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$178$138 to $257
FacilityA hospital or hospital-owned outpatient department$162$126 to $269

How much rates vary

Facilitymedian $162 · 10th to 90th $102 to $603Professionalmedian $178 · 10th to 90th $107 to $447
$50$100$200$500$1Kfacility $162professional $178

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Arizona sits

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Arizona· 16th of 51

$178

MN $200DC $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.