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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 July 2026.

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

$135

Typical negotiated rate. In Washington, DC, July 2026.

Insurers have agreed to pay about $135 for this service. The price depends on where it is billed: about $135 from a physician practice, and about $302 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 5 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$135$110 to $170
FacilityA hospital or hospital-owned outpatient department$302$178 to $339

How much rates vary

Facilitymedian $302 · 10th to 90th $129 to $398Professionalmedian $135 · 10th to 90th $91 to $204
$50$100$200facility $302professional $135

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
$128.82
Median
$302.00
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$134.90
Typical High
$199.53
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$32.36
Median
$134.90
Typical High
$269.15
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$112.20
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$316.23
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$199.53
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$181.97
Typical High
$316.23
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$371.54

Where Washington, DC 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.

Washington, DC· 51st of 51

$135

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.