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Office Visit, New Patient (Moderate Complexity)

Rhode Island 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 October 2026.

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

$158

Typical negotiated rate. In Rhode Island, October 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $269 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$158$132 to $178
FacilityA hospital or hospital-owned outpatient department$269$174 to $339

How much rates vary

Facilitymedian $269 · 10th to 90th $151 to $380Professionalmedian $158 · 10th to 90th $126 to $209
$100$200$500facility $269professional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$131.83
Typical High
$165.96
Aetna
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$165.96
Typical High
$208.93
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$66.07
Median
$69.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.50
Median
$20.42
Typical High
$24.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.18
Median
$13.80
Typical High
$16.60
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$281.84
Typical High
$436.52
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$173.78
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$173.78
Typical High
$338.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$158.49
Typical High
$186.21
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$154.88
Typical High
$213.80

Where Rhode Island sits

The same service costs 2.3 times more in Alaska than in Alabama. 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.

Rhode Island· 21st of 51

$158

AK $263AL $115

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.