go back

Office Visit, New Patient (High Complexity)

Florida 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?

$204

Typical negotiated rate. In Florida, July 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $170 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 8 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$204$166 to $275
FacilityA hospital or hospital-owned outpatient department$170$138 to $219

How much rates vary

Facilitymedian $170 · 10th to 90th $126 to $447Professionalmedian $204 · 10th to 90th $141 to $447
$10$20$50$100$200$500$1Kfacility $170professional $204

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
$128.82
Median
$169.82
Typical High
$446.68
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$42.66
Median
$309.03
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$204.17
Typical High
$446.68
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$177.83
Median
$302.00
Typical High
$660.69
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$229.09
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$229.09
Typical High
$331.13
AvMed
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$165.96
Typical High
$181.97
AvMed
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$190.55
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$181.97
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$229.09
Typical High
$398.11
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$263.03
Typical High
$416.87
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$275.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$186.21
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$91.20
Typical High
$426.58
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$169.82
Typical High
$234.42

Where Florida 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.

Florida· 36th of 51

$204

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.