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Office Visit, New Patient (High Complexity)

North Carolina 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?

$229

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $229 for this service. The price depends on where it is billed: about $229 from a physician practice, and about $224 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$229$178 to $363
FacilityA hospital or hospital-owned outpatient department$224$178 to $288

How much rates vary

Facilitymedian $224 · 10th to 90th $158 to $389Professionalmedian $229 · 10th to 90th $141 to $525
$50$100$200$500$1Kfacility $224professional $229

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
$165.96
Median
$223.87
Typical High
$436.52
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$251.19
Median
$275.42
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$588.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$120.23
Median
$263.03
Typical High
$676.08
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$223.87
Typical High
$354.81
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$177.83
Median
$229.09
Typical High
$363.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$281.84
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$229.09
Typical High
$407.38
Medcost
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$407.38
Medcost
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$223.87
Typical High
$354.81
Medcost
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$512.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$501.19
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$158.49
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$199.53
Typical High
$363.08
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$269.15
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38

Where North Carolina 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.

North Carolina· 17th of 51

$229

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.