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Office Visit, New Patient (Moderate Complexity)

Missouri 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.

Facilitymedian $148 · 10th–90th $95$3470%10%20%10th90th$148Professionalmedian $178 · 10th–90th $105$4170%10%20%10th90th$178$1.0$5.0$20.0$100.0$500.0$2.0K

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
$95.50
Median
$141.25
Typical High
$281.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$346.74
Median
$575.44
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$169.82
Typical High
$398.11
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$199.53
Typical High
$436.52
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$165.96
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$223.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$147.91
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$281.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$162.18
Typical High
$275.42
Medica
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$204.17
Typical High
$1,047.13
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$154.88
Median
$194.98
Typical High
$269.15
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$281.84
Qualchoice
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$204.17
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$120.23
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$154.88
Typical High
$251.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$97.72
Typical High
$323.59