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Office Visit, New Patient (Moderate Complexity)

Washington, DC 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 October 2026.

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

$129

Typical physician fee. In Washington, DC, October 2026.

Insurers have agreed to pay about $129 for this service. Most negotiated rates run $115 to $158.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $195 · 10th to 90th $110 to $407Professionalmedian $129 · 10th to 90th $98 to $200
$100$200$500facility $195professional $129

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$186.21
Typical High
$407.38
Aetna
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$128.82
Typical High
$181.97
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$61.66
Median
$64.57
Typical High
$83.18
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$18.62
Median
$19.50
Typical High
$24.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$12.30
Median
$12.88
Typical High
$16.60
CareFirst
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$120.23
Typical High
$134.90
Cigna
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$147.91
Typical High
$234.42
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$199.53
Typical High
$323.59
United
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$147.91
Typical High
$288.40

Where Washington, DC sits

The same service costs 2.3 times more in Alaska than in Alabama. 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.

Washington, DC· 48th of 51

$129

AK $263AL $115

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.