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Office Visit, New Patient (Moderate Complexity)

New Jersey 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 $126 · 10th–90th $76$3390%10%10th90th$126Professionalmedian $170 · 10th–90th $102$3890%10%10th90th$170$10.0$50.0$200.0$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
$75.86
Median
$125.89
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$181.97
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$117.49
Median
$169.82
Typical High
$223.87
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$2,951.21
Typical High
$2,951.21
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$173.78
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$309.03
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$104.71
Typical High
$295.12
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$194.98
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$147.91
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$151.36
Typical High
$316.23
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$309.03