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Office Visit, New Patient (Moderate Complexity)

Utah 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 $282 · 10th–90th $182$3470%20%10th90th$282Professionalmedian $182 · 10th–90th $105$4680%10%10th90th$182$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
$181.97
Median
$281.84
Typical High
$346.74
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$478.63
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$181.97
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$309.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$234.42
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$263.03
Select Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$181.97
Typical High
$512.86
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$199.53
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$281.84
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$144.54
Typical High
$208.93