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Office Visit, New Patient (Moderate Complexity)

Delaware 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?

$138

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $138 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $132 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 4 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$138$112 to $174
FacilityA hospital or hospital-owned outpatient department$132$120 to $174

How much rates vary

Facilitymedian $132 · 10th to 90th $105 to $200Professionalmedian $138 · 10th to 90th $95 to $240
$100$200$500facility $132professional $138

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
$104.71
Median
$131.83
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$239.88
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$229.09
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$165.96
Typical High
$269.15
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$295.12
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$173.78
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$275.42
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$257.04

Where Delaware 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.

Delaware· 50th of 51

$138

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.