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Office Visit, New Patient (Moderate Complexity)

Wisconsin 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 $105$3630%10%20%10th90th$155Professionalmedian $219 · 10th–90th $105$5130%10%10th90th$219$1.0$5.0$20.0$100.0$500.0

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
$107.15
Median
$194.98
Typical High
$426.58
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$51.29
Median
$309.03
Typical High
$436.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$537.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$269.15
Typical High
$575.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$218.78
Typical High
$398.11
CareSource
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$151.36
Typical High
$173.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$199.53
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$524.81
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$275.42
Typical High
$478.63
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$309.03
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$309.03
Typical High
$426.58
Medica
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$316.23
Medica
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$354.81
Typical High
$1,047.13
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$234.42
Median
$398.11
Typical High
$489.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$169.82
Network Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$234.42
Typical High
$380.19
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$309.03
Quartz
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$295.12
Typical High
$446.68
Quartz
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$831.76
Quartz
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$257.04
Typical High
$1,047.13
Security Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$194.98
Security Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$269.15
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$95.50
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$323.59
Typical High
$446.68
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$97.72
Typical High
$263.03