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Office Visit, New Patient (Moderate Complexity)

Virginia 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 $166 · 10th–90th $112$2630%20%10th90th$166Professionalmedian $170 · 10th–90th $98$3240%20%10th90th$170$1.0$5.0$20.0$100.0$500.0$2.0K

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
$97.72
Median
$141.25
Typical High
$218.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$229.09
Median
$234.42
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$302.00
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$91.20
Median
$186.21
Typical High
$363.08
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$323.59
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$112.20
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$281.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$295.12
Medcost
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$177.83
Typical High
$239.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$275.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$302.00
Sentara
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$147.91
Typical High
$245.47
Sentara
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$186.21
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$128.82
Typical High
$177.83
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$158.49
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$162.18
Typical High
$323.59