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Office Visit, New Patient (Moderate Complexity)

Idaho 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.

How much does Office Visit, New Patient (Moderate Complexity) cost?

$191

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $191 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$191$151 to $275
FacilityA hospital or hospital-owned outpatient department$191$141 to $240

How much rates vary

Facilitymedian $191 · 10th to 90th $112 to $288Professionalmedian $191 · 10th to 90th $120 to $457
$50$100$200$500facility $191professional $191

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$213.80
Typical High
$281.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$117.49
Median
$144.54
Typical High
$501.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$457.09
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$204.17
Typical High
$575.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$269.15
Typical High
$338.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$194.98
Typical High
$295.12
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$309.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$234.42
Typical High
$354.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$323.59
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$218.78
Typical High
$338.84
Select Health
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$213.80
Typical High
$245.47
Select Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$199.53
Typical High
$316.23
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$87.10
Median
$89.13
Typical High
$263.03

Where Idaho sits

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Idaho· 4th of 51

$191

MN $200DC $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.