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Office Visit, New Patient (Moderate Complexity)

Florida 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 Florida, 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 $138 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 8 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$129 to $209
FacilityA hospital or hospital-owned outpatient department$138$110 to $275

How much rates vary

Facilitymedian $138 · 10th to 90th $105 to $407Professionalmedian $158 · 10th to 90th $107 to $339
$20$50$100$200$500facility $138professional $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
$104.71
Median
$138.04
Typical High
$407.38
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$288.40
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$338.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$190.55
Typical High
$467.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$239.88
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$173.78
Typical High
$239.88
AvMed
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$123.03
Typical High
$134.90
AvMed
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$181.97
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$316.23
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$263.03
Typical High
$416.87
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$144.54
Typical High
$208.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$138.04
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$141.25
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$181.97
Typical High
$323.59
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$128.82
Typical High
$177.83

Where Florida 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.

Florida· 38th 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.