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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 July 2026.

Facilitymedian $166 · 10th–90th $132$4170%20%10th90th$166Professionalmedian $170 · 10th–90th $110$3390%10%20%10th90th$170$20.0$50.0$100.0$200.0$500.0$1.0K

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
$131.83
Median
$165.96
Typical High
$616.60
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$239.88
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$165.96
Typical High
$323.59
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$107.15
Median
$181.97
Typical High
$398.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$194.98
Typical High
$380.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$169.82
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$275.42
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$263.03