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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.

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

$166

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $166 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 8 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$166$129 to $214
FacilityA hospital or hospital-owned outpatient department$166$129 to $204

How much rates vary

Facilitymedian $166 · 10th to 90th $112 to $257Professionalmedian $166 · 10th to 90th $102 to $302
$50$100$200$500facility $166professional $166

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
$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

Where Virginia 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.

Virginia· 29th of 51

$166

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.