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Office Visit, New Patient (Moderate Complexity)

Washington 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 $191 · 10th–90th $115$3390%10%10th90th$191Professionalmedian $191 · 10th–90th $110$4680%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$309.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$144.54
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$186.21
Typical High
$457.09
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$91.20
Median
$199.53
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$199.53
Typical High
$323.59
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$199.53
Typical High
$331.13
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$251.19
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$204.17
Typical High
$407.38
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$338.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$173.78
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$83.18
Typical High
$181.97
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$309.03
Typical High
$331.13
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$234.42
Typical High
$407.38
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$251.19
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$213.80
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$173.78
Typical High
$323.59
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$245.47