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Office Visit, New Patient (Moderate Complexity)

Kentucky 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?

$174

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $120 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 7 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$174$132 to $257
FacilityA hospital or hospital-owned outpatient department$120$102 to $141

How much rates vary

Facilitymedian $120 · 10th to 90th $87 to $170Professionalmedian $174 · 10th to 90th $105 to $427
$20$50$100$200$500facility $120professional $174

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
$87.10
Median
$114.82
Typical High
$141.25
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$537.03
Median
$537.03
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$177.83
Typical High
$436.52
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$100.00
Median
$199.53
Typical High
$549.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$165.96
Typical High
$229.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$190.55
Anthem BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
CareSource
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$138.04
Typical High
$186.21
CareSource
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$173.78
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$169.82
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$102.33
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$162.18
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$263.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$158.49
Typical High
$263.03

Where Kentucky 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.

Kentucky· 19th of 51

$174

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.