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Office Visit, New Patient (Moderate Complexity)

New York 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 $148 · 10th–90th $91$4790%20%10th90th$148Professionalmedian $178 · 10th–90th $81$4470%10%20%10th90th$178$0.1$0.5$2.0$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
$91.20
Median
$138.04
Typical High
$467.74
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$223.87
Median
$436.52
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$177.83
Typical High
$436.52
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$194.98
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$120.23
Median
$169.82
Typical High
$204.17
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$912.01
Typical High
$977.24
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.79
Median
$112.20
Typical High
$251.19
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$199.53
Typical High
$380.19
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$147.91
Emblem Health
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$0.10
Median
$0.10
Typical High
$0.10
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$104.71
Typical High
$295.12
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$45.71
Typical High
$186.21
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$338.84
Fidelis
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$173.78
Typical High
$213.80
Fidelis
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$158.49
Typical High
$288.40
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$295.12
Typical High
$741.31
Highmark BCBS
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$575.44
Median
$575.44
Typical High
$724.44
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$213.80
Typical High
$275.42
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$213.80
Typical High
$275.42
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$380.19
Optum
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$181.97
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$131.83
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$123.03
Typical High
$446.68
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$131.83
Typical High
$323.59
Univera
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$109.65
Typical High
$199.53
Univera
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$331.13