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Office Visit, New Patient (Moderate Complexity)

Indiana 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?

$141

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $141 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $110 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 6 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$145$115 to $186
FacilityA hospital or hospital-owned outpatient department$110$95.50 to $145

How much rates vary

Facilitymedian $110 · 10th to 90th $81 to $269Professionalmedian $145 · 10th to 90th $95 to $245
$50$100$200$500facility $110professional $145

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
$81.28
Median
$107.15
Typical High
$288.40
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$102.33
Median
$102.33
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$141.25
Typical High
$245.47
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$190.55
Typical High
$309.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$165.96
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$169.82
Typical High
$234.42
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$169.82
Typical High
$251.19
CareSource
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$169.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$190.55
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$114.82
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$162.18
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$131.83
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$275.42
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$158.49
Typical High
$323.59

Where Indiana 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.

Indiana· 47th of 51

$141

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.