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Office Visit, New Patient (High Complexity)

Illinois 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?

$224

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $224 for this service. The price depends on where it is billed: about $224 from a physician practice, and about $229 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 7 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$224$170 to $302
FacilityA hospital or hospital-owned outpatient department$229$155 to $316

How much rates vary

Facilitymedian $229 · 10th to 90th $126 to $339Professionalmedian $224 · 10th to 90th $141 to $490
$100$200$500$1Kfacility $229professional $224

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
$125.89
Median
$229.09
Typical High
$338.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$190.55
Median
$288.40
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$223.87
Typical High
$512.86
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$281.84
Typical High
$707.95
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$223.87
Typical High
$316.23
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$229.09
Typical High
$323.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$602.56
Typical High
$630.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$380.19
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$288.40
Typical High
$575.44
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$263.03
Typical High
$436.52
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$91.20
Typical High
$457.09

Where Illinois 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.

Illinois· 20th of 51

$224

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.