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Office Visit, New Patient (Moderate Complexity)

Nebraska 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 $224 · 10th–90th $129$3980%10%10th90th$224Professionalmedian $204 · 10th–90th $107$3630%10%10th90th$204$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
$138.04
Median
$269.15
Typical High
$630.96
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$169.82
Typical High
$354.81
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$302.00
Typical High
$371.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$199.53
Typical High
$338.84
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$141.25
Median
$223.87
Typical High
$346.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$338.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$223.87
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$245.47
Typical High
$389.05
Medica
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$281.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$302.00
Typical High
$831.76
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$245.47
Median
$316.23
Typical High
$407.38
Midlands
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$263.03
Typical High
$323.59
Midlands
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$281.84
Typical High
$371.54
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$288.40
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$165.96
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$151.36
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$204.17
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$181.97
Typical High
$263.03