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Office Visit, New Patient (Moderate Complexity)

Iowa 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 $195 · 10th–90th $110$3470%10%10th90th$195Professionalmedian $195 · 10th–90th $102$4570%5%10th90th$195$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
$112.20
Median
$229.09
Typical High
$346.74
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$213.80
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$186.21
Typical High
$478.63
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$93.33
Median
$208.93
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$218.78
Typical High
$380.19
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$213.80
Typical High
$416.87
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$309.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$257.04
Typical High
$1,047.13
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$245.47
Median
$389.05
Typical High
$512.86
Midlands
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$275.42
Typical High
$407.38
Midlands
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$281.84
Typical High
$426.58
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$363.08
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$218.78
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$208.93
Typical High
$371.54
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$165.96
Typical High
$263.03
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$245.47