How much does new patient office visit, moderate complexity cost in Virginia?

CPT 99204 — the fair price, every hospital's price, and the Medicare benchmark for Virginia.

Estimates only. Educational estimates from public Medicare benchmarks and hospital-published prices — not a guarantee, and not legal, medical, or financial advice.
99204 New patient office visit, moderate complexity
Market typical price
$219
43 facilities · typical range $158 – $406 · 1.3× Medicare PFS
What Medicare pays
$163
Market typical
$219
Cash / self-pay price
$304
Prices near you — 43 facilities, lowest first
FacilityTypePricevs MedicareQuality
Ballad Health Johnston Memorial Hospital (Abingdon) lowest Hospital $51cash 0.3× ★★★★★
hip/knee complications 6.2%
Ballad Health Lonesome Pine Hospital (Big Stone Gap) Hospital $51cash 0.3× ★★★★★
Ballad Health Russell County Hospital (Lebanon) Hospital $51cash 0.3× ★★★★★
Ballad Health Smyth County Community Hospital (Marion) Hospital $51cash 0.3× ★★★★★
hip/knee complications 4.4%
UVA Health University Medical Center (Charlottesville) Hospital $56cash 0.3× ★★★★★
hip/knee complications 4.3%
UVA Health Culpeper Medical Center (Culpeper) Hospital $138cash 0.8× ★★★★★
Bon Secours St. Francis Medical Center (Midlothian) Hospital $146cash 0.9× ★★★★★
hip/knee complications 4.0%
Bon Secours Harbour View Medical Center (Suffolk) Hospital $151cash 0.9× —
Bon Secours Mary Immaculate Hospital (Newport News) Hospital $151cash 0.9× ★★★★★
hip/knee complications 4.7%
Bon Secours Maryview Medical Center (Portsmouth) Hospital $151cash 0.9× ★★★★★
Carilion New River Valley Medical Center (Christiansburg) Hospital $158cash 1.0× ★★★★★
Carilion Roanoke Memorial Hospital (Roanoke) Hospital $158cash 1.0× ★★★★★
hip/knee complications 7.9%
Prices from each hospital's public machine-readable file; imaging & surgery-center prices are published self-pay rates (often the cheapest option). vs Medicare is how many times the Medicare rate each facility charges. 2 unusually low/high prices excluded from the typical price as likely data errors.
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What should 99204 cost in Virginia?

For new patient office visit, moderate complexity (CPT 99204) in Virginia, a fair self-pay price is around $219, with hospitals ranging from $158 to $406 across 43 facilities. Medicare's benchmark rate is $163, the benchmark every published rate is measured against. The card above lists each hospital's price, cheapest first, with CMS quality stars.

Frequently asked questions

How much does new patient office visit, moderate complexity cost in Virginia?

A fair self-pay price for new patient office visit, moderate complexity (CPT 99204) in Virginia is around $219, with hospital prices ranging from $158 to $406 across 43 facilities. These are estimates from hospital-published prices, not a guarantee.

What is the Medicare rate for CPT 99204?

Medicare pays about $163 for new patient office visit, moderate complexity (CPT 99204). That's the negotiation floor — a fair cash-pay target is roughly 1.5–2× it, well below typical gross charges.

Can I negotiate the price of new patient office visit, moderate complexity?

Yes. Under the federal Hospital Price Transparency rule hospitals must publish these rates, so you can ask to pay the cash or negotiated rate instead of the gross charge. Paste your bill on the home page for a ready-to-send appeal letter and the exact numbers to cite.

Placing a referral for this?

Enter the patient's ZIP and plan in the facility finder to see every facility near them that publishes a price for 99204, ranked, with the phone number and an out-of-pocket estimate.

Compare other procedures in Virginia

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Prices last refreshed September 2026 from each hospital's official CMS machine-readable file. Medicare rate: CY2025 OPPS/PFS/CLFS. Estimates only — not a guarantee.