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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.

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

$151

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $158 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$151$117 to $200
FacilityA hospital or hospital-owned outpatient department$158$123 to $204

How much rates vary

Facilitymedian $158 · 10th to 90th $105 to $269Professionalmedian $151 · 10th to 90th $87 to $331
$50$100$200$500facility $158professional $151

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
$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

Where South Carolina 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.

South Carolina· 46th of 51

$151

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.