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Rhode Island

Cost of a Primary Care Doctor (Family Medicine) Visit
in Rhode Island

Reviewed by Momentary Medical Group West PC

Rhode Island's compact geography concentrates most healthcare delivery within a 30-minute drive of Providence, yet the state maintains only 5 active Primary Care Doctor (Family Medicine) providers serving its entire population of 1.1 million residents. Based on current insurer negotiated rates, patients typically pay between $85 and $200 for a Primary Care Doctor (Family Medicine) visit, with a median out-of-pocket cost of $144. These rates run approximately 13% above national averages, reflecting the state's higher cost structure and limited provider competition across its 39 cities and towns.

Average

$143

Median

$144

Lowest

$85

Highest

$200

Providers

5

National avg: $129Rhode Island: $143

11% above national average

Compare Similar Procedures

How does family medicine visit compare to related procedures in Rhode Island?

ProcedureCPTLowMedianHighProviders
Internal Medicine Visit

Standard office visit with an internist

99214$80$88$20013

Important: These are cost estimates only — not a quote and not medical advice.

The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 99214Office/outpatient visit, established patient, moderate complexity). They represent what a patient might pay without insurance.

Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.

This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.

Where this data comes from & what CPT 99214 covers

Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 99214 (Office/outpatient visit, established patient, moderate complexity), as mandated by the CMS Price Transparency Rule.

What CPT 99214 covers: the provider's professional fee for family medicine visit. It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.

How to read this data

Negotiated Rate

The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.

P5, Median, P95

P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.

What this does not tell you

These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.

Top Rated Family medicine physicians in Rhode Island

Why Primary Care Doctor (Family Medicine) Visit Costs Vary Across Rhode Island

Rhode Island's healthcare costs run approximately 13% above national averages, reflecting the state's high cost of living and concentrated provider market within the smallest state geography. The Ocean State's unique position between the expensive Boston and New York markets creates upward pressure on physician compensation and facility overhead costs.

Urban vs. Rural Provider Availability

Rhode Island's urban concentration around Providence, Warwick, and Newport creates relatively uniform access to Primary Care Doctor (Family Medicine) services across the state's 1,214 square miles. Unlike truly rural states, most Rhode Island residents can reach specialty care within 30 minutes, though the limited provider pool of just 5 active practitioners creates potential scheduling delays. The state's coastal geography and dense population distribution minimize the dramatic cost disparities seen in states with vast rural regions.

Facility Type and Overhead Costs

Hospital-based outpatient clinics affiliated with systems like Lifespan and Care New England typically charge higher facility fees for Primary Care Doctor (Family Medicine) visits compared to independent practices. Rhode Island's high commercial real estate costs and strict zoning regulations in many communities increase overhead expenses for all medical practices. The state's emphasis on quality reporting and electronic health record requirements also adds administrative costs that providers pass through to patients.

Insurance Market Competition in Rhode Island

BCBS RI dominates the state's individual and small group markets, while UHC and Tufts provide additional options primarily through larger employers and Medicare Advantage plans. This concentrated market structure limits competitive pressure on negotiated rates for Primary Care Doctor (Family Medicine) services compared to states with more diverse insurer participation. The state's small population base also reduces insurers' ability to achieve significant economies of scale when contracting with providers.

Physician Supply and Demand in Rhode Island

With only 5 active Primary Care Doctor (Family Medicine) providers serving Rhode Island's population of over one million residents, the state faces a significant shortage that drives up costs and extends wait times for appointments. This limited supply reflects both the challenges of practicing in a high-cost state and competition from nearby Massachusetts and Connecticut markets that may offer better compensation packages. The shortage particularly affects patients seeking same-day or urgent care visits, often forcing them toward more expensive emergency department alternatives.

Cost by Procedure Type

Family Medicine Visit can be billed under different CPT codes depending on what's done during the procedure in Rhode Island.

CPT 992135 providers

Follow-up, low complexity

$92
Range: $61$137
CPT 992145 providers

Follow-up, moderate complexity

$144
Range: $85$200
CPT 992155 providers

Follow-up, high complexity

$169
Range: $85$269
CPT 992035 providers

New patient, low complexity

$134
Range: $76$205
CPT 992045 providers

New patient, moderate complexity

$188
Range: $85$307
CPT 992055 providers

New patient, high complexity

$251
Range: $149$385

Costs shown are median negotiated rates. Your actual cost depends on your insurance plan and provider.

JP

Jayant Panwar

CEO, Momentary Labs · San Francisco, CA

Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.

The cost figures on this page reflect his ongoing work to make this data accessible to patients.

Healthcare Data AnalyticsCMS TiC DataInsurance Price Transparency

Frequently Asked Questions — Primary Care Doctor (Family Medicine) Costs in Rhode Island

What is the average cost of a Primary Care Doctor (Family Medicine) visit in Rhode Island without insurance?

Without insurance, Primary Care Doctor (Family Medicine) visits in Rhode Island typically cost between $85 and $200, with a median cost of $144 based on current negotiated rates. New patient visits requiring comprehensive evaluation can reach the higher end of this range, while follow-up visits for established patients often fall closer to $85-$143. Many providers offer self-pay discounts of 10-30% for uninsured patients who pay at the time of service.

Does Rhode Island Medicaid cover Primary Care Doctor (Family Medicine) visits?

Yes, Rhode Island Medicaid (RIte Care) covers Primary Care Doctor (Family Medicine) visits for eligible beneficiaries, as the state expanded Medicaid under the Affordable Care Act. Coverage includes both preventive and treatment visits with minimal or no copayments for most services. Patients should verify that their chosen provider accepts Medicaid, as some practices limit the number of Medicaid patients they see due to lower reimbursement rates.

How do I find an affordable Primary Care Doctor (Family Medicine) near me in Rhode Island?

Compare costs across Rhode Island's 5 active Primary Care Doctor (Family Medicine) providers by requesting price estimates before scheduling, as costs can vary significantly between independent practices and hospital-owned clinics. Look into community health centers like Thundermist Health Center, which offer sliding fee scales based on income. Many providers also offer cash-pay discounts for uninsured patients, so always ask about self-pay pricing options.

What is the difference in cost between an initial consultation and a follow-up visit?

Initial consultations with a Primary Care Doctor (Family Medicine) in Rhode Island typically cost $133-$251 (median $134-$251), while follow-up visits for established patients range from $85-$169 (median $92-$169). New patient visits often require more comprehensive evaluation and documentation, justifying the higher cost. The complexity of your medical condition and time required will determine where your visit falls within these ranges.

Can I use an HSA or FSA to pay for a Primary Care Doctor (Family Medicine) visit in Rhode Island?

Yes, Primary Care Doctor (Family Medicine) visits are qualified medical expenses that can be paid using Health Savings Account (HSA) or Flexible Spending Account (FSA) funds. This includes both preventive and treatment visits, along with any associated laboratory tests or procedures ordered during your appointment. Keep all receipts and documentation for tax purposes, as you may need to provide proof that expenses were medically necessary.

How does telemedicine affect the cost of seeing a Primary Care Doctor (Family Medicine) in Rhode Island?

Telemedicine visits with a Primary Care Doctor (Family Medicine) in Rhode Island are often priced 10-20% lower than in-person visits, though exact savings vary by provider and insurance plan. Rhode Island has maintained expanded telehealth coverage policies implemented during the COVID-19 pandemic, making virtual visits more accessible and affordable. However, certain conditions requiring physical examination or diagnostic tests will still necessitate in-person visits at standard pricing.

Click a state to compare costs

Average Visit Cost

$80
$215

Office visit (CPT 99214)

Compare With Other States

RankStateAverage
1Nebraska
Range: $91$314
$215
2New Hampshire
Range: $101$282
$198
3Iowa
Range: $80$314
$187
4Maine
Range: $80$255
$180
5Minnesota
Range: $81$313
$162
6Wisconsin
Range: $73$313
$161
7California
Range: $70$250
$154
8Wyoming
Range: $80$251
$152
9Illinois
Range: $77$226
$148
10Massachusetts
Range: $80$271
$144
11Rhode Island
Range: $85$200
$143
12North Dakota
Range: $91$240
$141
13Texas
Range: $70$221
$139
14New Mexico
Range: $80$178
$138
15Vermont
Range: $107$166
$138
16Mississippi
Range: $67$249
$136
17Michigan
Range: $66$249
$134
18South Dakota
Range: $77$239
$132
19Hawaii
Range: $70$239
$131
20New York
Range: $78$200
$131
21Pennsylvania
Range: $73$228
$130
22Louisiana
Range: $69$222
$130
23Colorado
Range: $80$210
$126
24Connecticut
Range: $80$200
$124
25Oregon
Range: $80$204
$124
26Indiana
Range: $80$202
$123
27Ohio
Range: $70$201
$122
28Georgia
Range: $72$188
$122
29South Carolina
Range: $68$216
$121
30Washington
Range: $80$202
$121
31North Carolina
Range: $66$210
$119
32Nevada
Range: $48$182
$118
33Virginia
Range: $60$191
$116
34Arkansas
Range: $70$175
$116
35West Virginia
Range: $80$133
$115
36Florida
Range: $54$200
$115
37Idaho
Range: $75$179
$115
38New Jersey
Range: $53$188
$113
39Missouri
Range: $67$148
$113
40Kansas
Range: $76$158
$113
41Maryland
Range: $49$194
$112
42District of Columbia
Range: $53$199
$112
43Kentucky
Range: $80$170
$110
44Utah
Range: $60$180
$110
45Tennessee
Range: $70$168
$109
46Oklahoma
Range: $70$158
$104
47Arizona
Range: $63$168
$104
48Alabama
Range: $61$160
$100
49Delaware
Range: $58$123
$91
50Alaska
Range: $80$80
$80
51Montana
Range: $80$80
$80
Family Medicine Visit in Other States