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Office Visit, New Patient (High Complexity)

Kentucky 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 Kentucky, July 2026.

Insurers have agreed to pay about $209 for this service. The price depends on where it is billed: about $214 from a physician practice, and about $158 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$214$158 to $339
FacilityA hospital or hospital-owned outpatient department$158$138 to $186

How much rates vary

Facilitymedian $158 · 10th to 90th $117 to $229Professionalmedian $214 · 10th to 90th $132 to $661
$50$100$200$500$1Kfacility $158professional $214

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
$117.49
Median
$147.91
Typical High
$190.55
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$218.78
Typical High
$676.08
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$316.23
Typical High
$741.31
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$223.87
Typical High
$302.00
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$223.87
Typical High
$295.12
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$234.42
CareSource
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$251.19
CareSource
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$234.42
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$223.87
Typical High
$1,148.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$134.90
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$323.59
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$213.80
Typical High
$295.12

Where Kentucky 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.

Kentucky· 31st 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.