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Office Visit, New Patient (Moderate Complexity)

West 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.

Facilitymedian $117 · 10th–90th $44$2630%10%10th90th$117Professionalmedian $174 · 10th–90th $98$3240%5%10%10th90th$174$10.0$20.0$50.0$100.0$200.0$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
$43.65
Median
$69.18
Typical High
$169.82
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$46.77
Median
$158.49
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$162.18
Typical High
$309.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$123.03
Median
$204.17
Typical High
$331.13
CareSource
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$169.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$165.96
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$851.14
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$186.21
Typical High
$229.09
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$177.83
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$141.25
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$151.36
Typical High
$251.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$208.93