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Office Visit, New Patient (Moderate Complexity)

North Carolina 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 $170 · 10th–90th $112$3090%10%10th90th$170Professionalmedian $178 · 10th–90th $87$3980%5%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
$117.49
Median
$162.18
Typical High
$323.59
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$47.86
Median
$229.09
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$165.96
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$181.97
Typical High
$467.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$257.04
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$173.78
Typical High
$269.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$218.78
Typical High
$354.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$316.23
Medcost
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$177.83
Typical High
$309.03
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$275.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$407.38
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$213.80
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$288.40
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$97.72
Typical High
$323.59
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,047.13