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Office Visit, New Patient (Moderate Complexity)

New Mexico 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.

How much does Office Visit, New Patient (Moderate Complexity) cost?

$166

Typical negotiated rate. In New Mexico, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $166 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$166$132 to $224
FacilityA hospital or hospital-owned outpatient department$166$132 to $214

How much rates vary

Facilitymedian $166 · 10th to 90th $115 to $275Professionalmedian $166 · 10th to 90th $110 to $389
$50$100$200$500facility $166professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$416.87
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$204.17
Typical High
$549.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$102.33
Median
$158.49
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$147.91
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$186.21
Typical High
$269.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$251.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$281.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$199.53
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$158.49
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$186.21
Typical High
$323.59
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$177.83
Typical High
$323.59

Where New Mexico sits

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New Mexico· 32nd of 51

$166

MN $200DC $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.