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Office Visit, New Patient (Moderate Complexity)

California 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 $120$3090%20%10th90th$170Professionalmedian $195 · 10th–90th $123$5370%20%10th90th$195$1.0$5.0$20.0$100.0$500.0$2.0K

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
$123.03
Median
$169.82
Typical High
$363.08
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$389.05
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$194.98
Typical High
$524.81
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$199.53
Typical High
$549.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$173.78
Typical High
$251.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$165.96
Typical High
$186.21
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$173.78
Typical High
$302.00
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$87.10
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$114.82
Typical High
$316.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$151.36
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$323.59
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$128.82
Typical High
$257.04
HealthNet
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$407.38
Typical High
$616.60
HealthNet
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$194.98
Median
$194.98
Typical High
$199.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$181.97
Typical High
$309.03
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$239.88
Typical High
$1,047.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$93.33
Typical High
$239.88
Optum
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$269.15
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$275.42
Providence
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$186.21
Typical High
$363.08
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$331.13
Typical High
$426.58
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$104.71
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$141.25
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$131.83
Typical High
$251.19