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Office Visit, New Patient (High Complexity)

Georgia 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?

$209

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $209 for this service. The price depends on where it is billed: about $209 from a physician practice, and about $186 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$209$170 to $316
FacilityA hospital or hospital-owned outpatient department$186$155 to $251

How much rates vary

Facilitymedian $186 · 10th to 90th $145 to $457Professionalmedian $209 · 10th to 90th $141 to $479
$50$100$200$500$1Kfacility $186professional $209

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
$186.21
Typical High
$467.74
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$467.74
Median
$776.25
Typical High
$776.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$489.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$269.15
Typical High
$660.69
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$234.42
Typical High
$371.54
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$186.21
Median
$239.88
Typical High
$371.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$213.80
Typical High
$371.54
CareSource
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$245.47
CareSource
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$263.03
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$229.09
Typical High
$380.19
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$263.03
Typical High
$457.09
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$302.00
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$213.80
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$426.58

Where Georgia 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.

Georgia· 32nd of 51

$209

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.