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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.

Facilitymedian $195 · 10th–90th $115$8320%10%20%10th90th$195Professionalmedian $170 · 10th–90th $105$3800%10%10th90th$170$10.0$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
$114.82
Median
$173.78
Typical High
$218.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$194.98
Median
$676.08
Typical High
$676.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$162.18
Typical High
$354.81
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$194.98
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$165.96
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$169.82
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
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
$83.18
Median
$107.15
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$257.04
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$181.97
Typical High
$354.81