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Office Visit, New Patient (Moderate Complexity)

Texas 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 $110$4170%5%10%10th90th$174Professionalmedian $158 · 10th–90th $105$3310%10%10th90th$158$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
$107.15
Median
$151.36
Typical High
$630.96
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$457.09
Typical High
$933.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$162.18
Typical High
$331.13
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$93.33
Median
$186.21
Typical High
$457.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$165.96
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$173.78
Typical High
$213.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$181.97
Typical High
$602.56
BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$128.82
Typical High
$165.96
Baylor Scott & White
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$275.42
Typical High
$501.19
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$316.23
Christus
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$134.90
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$173.78
Typical High
$288.40
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$831.76
Typical High
$831.76
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$1,047.13
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$295.12
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$229.09
Typical High
$323.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$53.70
Typical High
$95.50
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$288.40
Typical High
$295.12
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$263.03
Typical High
$645.65
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$295.12
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$134.90
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$257.04
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$229.09
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$169.82
Typical High
$239.88