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Office Visit, New Patient (Moderate Complexity)

Pennsylvania 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 $174 · 10th–90th $105$4470%10%20%10th90th$174Professionalmedian $178 · 10th–90th $107$3800%20%10th90th$178$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$104.71
Median
$154.88
Typical High
$446.68
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$354.81
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$190.55
Typical High
$436.52
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$269.15
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$173.78
Typical High
$245.47
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$2,570.40
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$158.49
Typical High
$190.55
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$223.87
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$158.49
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$165.96
Typical High
$269.15
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$100.00
Typical High
$354.81
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$158.49
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$316.23
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$331.13
Typical High
$416.87
Highmark BCBS
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$295.12
Median
$331.13
Typical High
$660.69
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$251.19
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$141.25
Median
$165.96
Typical High
$229.09
Independence Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$2,344.23
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$158.49
Typical High
$190.55
Johns Hopkins Employer Health Plan
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Johns Hopkins Employer Health Plan
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$245.47
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$371.54
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$354.81
Typical High
$588.84
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$331.13
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$194.98
Typical High
$457.09
Optum
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$173.78
Typical High
$208.93
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$229.09
Typical High
$363.08
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$181.97
Typical High
$338.84
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$295.12
Typical High
$398.11
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$97.72
Typical High
$323.59