go back

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.

Facilitymedian $155 · 10th–90th $120$1860%20%10th90th$155Professionalmedian $191 · 10th–90th $115$5500%10%10th90th$191$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

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