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Office Visit, New Patient (Moderate Complexity)

Massachusetts 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 $162 · 10th–90th $85$2950%10%10th90th$162Professionalmedian $195 · 10th–90th $110$4680%5%10%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
$125.89
Median
$181.97
Typical High
$251.19
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$524.81
Median
$691.83
Typical High
$758.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$467.74
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$213.80
Typical High
$537.03
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$446.68
Typical High
$831.76
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$524.81
AllWays Health Partners
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$107.15
Typical High
$218.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$316.23
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$263.03
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$194.98
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$346.74
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$100.00
Typical High
$190.55
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$158.49
Typical High
$295.12
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$446.68
Health New England
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$199.53
Typical High
$245.47
Health New England
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$269.15
Typical High
$537.03
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$446.68
Typical High
$831.76
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$524.81
Mass General Brigham
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$107.15
Typical High
$218.78
Tufts
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$186.21
Tufts
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$173.78
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$213.80
Typical High
$457.09
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$95.50
Typical High
$371.54