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Office Visit, New Patient (Moderate Complexity)

Vermont 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?

$182

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $182 for this service. The price depends on where it is billed: about $182 from a physician practice, and about $155 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 5 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$182$151 to $263
FacilityA hospital or hospital-owned outpatient department$155$123 to $186

How much rates vary

Facilitymedian $155 · 10th to 90th $120 to $186Professionalmedian $182 · 10th to 90th $117 to $513
$50$100$200$500facility $155professional $182

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$154.88
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$181.97
Typical High
$537.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$194.98
Typical High
$575.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$245.47
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$173.78
Typical High
$288.40
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$213.80
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$407.38
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$85.11
Typical High
$257.04

Where Vermont 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.

Vermont· 11th of 51

$182

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.