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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.

Facilitymedian $158 · 10th–90th $112$4070%20%10th90th$158Professionalmedian $174 · 10th–90th $102$4070%10%20%10th90th$174$1.0$5.0$20.0$100.0$500.0

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
$112.20
Median
$165.96
Typical High
$309.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$134.90
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$389.05
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$199.53
Typical High
$446.68
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
$125.89
Median
$186.21
Typical High
$275.42
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
$302.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$501.19
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$208.93
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$199.53
Typical High
$316.23
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$194.98
Typical High
$263.03