go back

Office Visit, New Patient (Moderate Complexity)

Georgia 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?

$166

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $141 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$166$132 to $234
FacilityA hospital or hospital-owned outpatient department$141$117 to $214

How much rates vary

Facilitymedian $141 · 10th to 90th $107 to $468Professionalmedian $166 · 10th to 90th $107 to $347
$50$100$200$500facility $141professional $166

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
$107.15
Median
$138.04
Typical High
$537.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$251.19
Median
$524.81
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$346.74
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$186.21
Typical High
$407.38
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$281.84
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$177.83
Typical High
$275.42
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$288.40
Anthem BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
CareSource
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$162.18
Typical High
$181.97
CareSource
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$199.53
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$177.83
Typical High
$295.12
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$346.74
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$257.04
Typical High
$588.84
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$218.78
Typical High
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$131.83
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$165.96
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$181.97
Typical High
$323.59

Where Georgia 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.

Georgia· 31st of 51

$166

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.