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Office Visit, New Patient (High Complexity)

New Jersey 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 New Jersey, 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 $251 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$209$166 to $282
FacilityA hospital or hospital-owned outpatient department$251$135 to $501

How much rates vary

Facilitymedian $251 · 10th to 90th $110 to $1,202Professionalmedian $209 · 10th to 90th $132 to $468
$50$100$200$500$1Kfacility $251professional $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
$109.65
Median
$251.19
Typical High
$1,202.26
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$204.17
Typical High
$489.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$251.19
Typical High
$645.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$213.80
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$229.09
Typical High
$281.84
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$223.87
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$186.21
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$234.42
Typical High
$398.11
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$104.71
Typical High
$398.11
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$194.98
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$194.98
Typical High
$407.38
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$91.20
Typical High
$338.84

Where New Jersey 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.

New Jersey· 28th 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.