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Office Visit, New Patient (Moderate Complexity)

Tennessee 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?

$155

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $155 for this service. The price depends on where it is billed: about $155 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 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$155$129 to $204
FacilityA hospital or hospital-owned outpatient department$166$126 to $219

How much rates vary

Facilitymedian $166 · 10th to 90th $115 to $832Professionalmedian $155 · 10th to 90th $105 to $316
$50$100$200$500facility $166professional $155

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
$107.15
Median
$165.96
Typical High
$218.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$194.98
Median
$194.98
Typical High
$676.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$316.23
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$109.65
Median
$204.17
Typical High
$457.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$169.82
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$275.42
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$1,047.13
Typical High
$1,047.13
Optum
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$173.78
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$154.88
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$275.42
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$181.97
Typical High
$354.81

Where Tennessee 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.

Tennessee· 40th of 51

$155

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.