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Office Visit, New Patient (High Complexity)

Missouri 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?

$219

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $219 for this service. The price depends on where it is billed: about $219 from a physician practice, and about $200 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$219$166 to $302
FacilityA hospital or hospital-owned outpatient department$200$151 to $263

How much rates vary

Facilitymedian $200 · 10th to 90th $132 to $331Professionalmedian $219 · 10th to 90th $135 to $550
$50$100$200$500$1Kfacility $200professional $219

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
$190.55
Typical High
$323.59
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$575.44
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$281.84
Typical High
$724.44
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
$177.83
Median
$223.87
Typical High
$316.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$288.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$223.87
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$223.87
Typical High
$371.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$208.93
Typical High
$363.08
Medica
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$263.03
Typical High
$1,380.38
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$204.17
Median
$269.15
Typical High
$380.19
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$251.19
Typical High
$331.13
Qualchoice
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$245.47
Median
$251.19
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$204.17
Typical High
$363.08
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$478.63

Where Missouri 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.

Missouri· 22nd of 51

$219

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.