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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.

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

$166

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $166 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 4 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$166$135 to $209
FacilityA hospital or hospital-owned outpatient department$166$132 to $195

How much rates vary

Facilitymedian $166 · 10th to 90th $132 to $417Professionalmedian $166 · 10th to 90th $112 to $324
$50$100$200$500facility $166professional $166

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
$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

Where Rhode Island 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.

Rhode Island· 28th of 51

$166

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.