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Office Visit, New Patient (Moderate Complexity)

South Dakota 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 $135 · 10th–90th $50$3800%20%10th90th$135Professionalmedian $162 · 10th–90th $105$3800%10%10th90th$162$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
$50.12
Median
$134.90
Typical High
$380.19
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$23.99
Median
$380.19
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$354.81
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$194.98
Typical High
$416.87
Avera
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$213.80
Avera
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$208.93
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$245.47
Typical High
$371.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$295.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$281.84
Typical High
$1,047.13
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$208.93
Median
$302.00
Typical High
$446.68
Midlands
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$257.04
Typical High
$323.59
Midlands
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$251.19
Typical High
$363.08
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$223.87
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$199.53
Typical High
$338.84
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$263.03
Typical High
$354.81
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$177.83
Typical High
$269.15