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Office Visit, New Patient (Moderate Complexity)

Montana 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 Montana, 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 $224 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 6 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$155 to $275
FacilityA hospital or hospital-owned outpatient department$224$170 to $275

How much rates vary

Facilitymedian $224 · 10th to 90th $129 to $302Professionalmedian $191 · 10th to 90th $123 to $457
$50$100$200$500facility $224professional $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
$47.86
Median
$204.17
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$190.55
Typical High
$467.74
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$190.55
Typical High
$549.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$223.87
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$208.93
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$354.81
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$295.12
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$295.12
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$181.97
Typical High
$316.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$251.19
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$213.80
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$97.72
Typical High
$263.03

Where Montana 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.

Montana· 7th 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.