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Office Visit, New Patient (Moderate Complexity)

Michigan 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 $138 · 10th–90th $87$1910%10%10th90th$138Professionalmedian $174 · 10th–90th $107$3980%10%10th90th$174$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
$87.10
Median
$138.04
Typical High
$181.97
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$190.55
Median
$234.42
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$371.54
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$190.55
Typical High
$457.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$169.82
Typical High
$234.42
BCBS
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$204.17
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$194.98
Typical High
$288.40
CareSource
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$234.42
CareSource
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$213.80
Typical High
$223.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$162.18
Typical High
$331.13
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$186.21
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$144.54
Typical High
$234.42
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$309.03
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$131.83
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$169.82
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$131.83
Typical High
$354.81