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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.

Facilitymedian $191 · 10th–90th $112$2880%10%10th90th$191Professionalmedian $195 · 10th–90th $120$5130%10%10th90th$195$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
$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