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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.

Facilitymedian $138 · 10th–90th $105$4070%20%10th90th$138Professionalmedian $166 · 10th–90th $107$3630%10%10th90th$166$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$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