Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
Idaho Pricing in Context
In Idaho, CPT code 99204 (New Patient Office Or Other Outpatient Visit, 45-59 Minutes) carries an average Medicare payment of $95.06 — 15% below the national benchmark of $111.40. 3.3K providers across the state submitted claims for this procedure in 2023, performing 58.6K total services. Individual payments in ID ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.
The average billed charge in Idaho is $323.78, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Idaho sits below the national Medicare average, commercial rates in the state may also run lower than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Office Visit procedures, the estimated commercial insurance price in Idaho lands near $289.47, with self-pay cash prices typically around $192.42. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does New Patient Office Or Other Outpatient Visit, 45-59 Minutes cost in Idaho?
The average Medicare payment for New Patient Office Or Other Outpatient Visit, 45-59 Minutes in Idaho is $95.06, which is 15% below the national average of $111.40. Providers in ID typically bill $323.78 for this procedure.
What does New Patient Office Or Other Outpatient Visit, 45-59 Minutes cost with insurance in Idaho?
With commercial insurance in Idaho, New Patient Office Or Other Outpatient Visit, 45-59 Minutes costs an estimated $289.47. Without insurance, the estimated cash price is $192.42. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform New Patient Office Or Other Outpatient Visit, 45-59 Minutes in Idaho?
3.3K providers in Idaho billed Medicare for New Patient Office Or Other Outpatient Visit, 45-59 Minutes in 2023, performing 58.6K total services. Medicare payments ranged from N/A to N/A depending on the provider.
Is New Patient Office Or Other Outpatient Visit, 45-59 Minutes cheaper in Idaho than the national average?
Yes — New Patient Office Or Other Outpatient Visit, 45-59 Minutes costs 15% below the national average in Idaho. The state average Medicare payment is $95.06 compared to $111.40 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.