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Office Visit, New Patient (High Complexity)

Delaware rates for HCPCS 99205

An initial, in-depth appointment with a doctor or provider the patient has not seen before, involving a high level of medical decision-making, such as managing multiple serious conditions or health issues that carry significant risk. It's the most involved level of a first-time office visit and typically takes considerably more time than a routine new-patient appointment. It reflects the most complex end of new-patient evaluations.

Rates data updated July 2026.

How much does Office Visit, New Patient (High Complexity) cost?

$174

Typical physician fee. In Delaware, July 2026.

Insurers have agreed to pay about $174 for this service. Most negotiated rates run $145 to $219.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $174 · 10th to 90th $145 to $1,000Professionalmedian $174 · 10th to 90th $126 to $302
$100$200$500$1Kfacility $174professional $174

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
$144.54
Median
$173.78
Typical High
$1,000.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$302.00
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$177.83
Median
$251.19
Typical High
$436.52
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$208.93
Typical High
$363.08
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$295.12
Typical High
$398.11
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$234.42
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$190.55
Typical High
$346.74
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$89.13
Typical High
$426.58

Where Delaware sits

The same service costs 1.7 times more in Minnesota than in Delaware. 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.

Delaware· 51st of 51

$174

MN $295DE $174

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.