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Office Visit, New Patient (Moderate Complexity)

Illinois 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?

$174

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $182 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 7 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$174$132 to $240
FacilityA hospital or hospital-owned outpatient department$182$115 to $229

How much rates vary

Facilitymedian $182 · 10th to 90th $93 to $302Professionalmedian $174 · 10th to 90th $105 to $363
$50$100$200$500facility $182professional $174

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
$93.33
Median
$181.97
Typical High
$302.00
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$190.55
Median
$263.03
Typical High
$416.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$194.98
Typical High
$457.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$173.78
Typical High
$239.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$275.42
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$154.88
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$295.12
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$213.80
Typical High
$436.52
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$190.55
Typical High
$223.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$120.23
Typical High
$177.83
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$199.53
Typical High
$331.13
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$177.83
Typical High
$323.59

Where Illinois 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.

Illinois· 18th of 51

$174

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.