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Office Visit, New Patient (Moderate Complexity)

Ohio 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 $120 · 10th–90th $49$1820%10%20%10th90th$120Professionalmedian $166 · 10th–90th $98$3470%5%10%10th90th$166$1.0$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
$48.98
Median
$123.03
Typical High
$204.17
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$107.15
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$331.13
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$194.98
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$169.82
Typical High
$229.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$234.42
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$275.42
CareSource
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$138.04
Typical High
$169.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$169.82
Typical High
$223.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$302.00
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$204.17
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$102.33
Optum
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$186.21
Typical High
$281.84
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$331.13
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$263.03