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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.

Facilitymedian $191 · 10th–90th $98$3160%10%10th90th$191Professionalmedian $178 · 10th–90th $105$3890%10%10th90th$178$5.0$20.0$100.0$500.0

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
$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