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Office Visit, New Patient (Moderate Complexity)

Colorado 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?

$158

Typical negotiated rate. In Colorado, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $178 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 7 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$158$123 to $200
FacilityA hospital or hospital-owned outpatient department$178$135 to $229

How much rates vary

Facilitymedian $178 · 10th to 90th $117 to $309Professionalmedian $158 · 10th to 90th $100 to $339
$50$100$200$500$1Kfacility $178professional $158

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
$112.20
Median
$151.36
Typical High
$501.19
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$177.83
Median
$177.83
Typical High
$416.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$154.88
Typical High
$346.74
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$190.55
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$281.84
Anthem 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
$141.25
Median
$151.36
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$309.03
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$281.84
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$501.19
Select Health
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Select Health
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$204.17
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$323.59
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$194.98
Typical High
$263.03

Where Colorado 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.

Colorado· 35th of 51

$158

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.