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Office Visit, New Patient (Moderate Complexity)

South Carolina 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 $162 · 10th–90th $105$2750%5%10%10th90th$162Professionalmedian $158 · 10th–90th $87$3470%10%10th90th$158$10.0$20.0$50.0$100.0$200.0$500.0$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
$95.50
Median
$138.04
Typical High
$218.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$181.97
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$151.36
Typical High
$338.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$173.78
Typical High
$363.08
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$257.04
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$169.82
Typical High
$257.04
BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$218.78
Typical High
$467.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$165.96
Typical High
$288.40
Medcost
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$177.83
Typical High
$204.17
Medcost
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$275.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$141.25
Typical High
$239.88
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$162.18
Typical High
$371.54