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Office Visit, New Patient (Moderate Complexity)

Utah 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?

$178

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $178 for this service. The price depends on where it is billed: about $178 from a physician practice, and about $282 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$178$145 to $263
FacilityA hospital or hospital-owned outpatient department$282$245 to $309

How much rates vary

Facilitymedian $282 · 10th to 90th $182 to $347Professionalmedian $178 · 10th to 90th $107 to $468
$50$100$200$500facility $282professional $178

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
$181.97
Median
$281.84
Typical High
$346.74
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$478.63
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$181.97
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$309.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$234.42
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$263.03
Select Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$181.97
Typical High
$512.86
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$199.53
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$281.84
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$144.54
Typical High
$208.93

Where Utah 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.

Utah· 15th of 51

$178

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.