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Office Visit, New Patient (High Complexity)

Rhode Island 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?

$214

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $214 for this service. The price depends on where it is billed: about $214 from a physician practice, and about $204 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 4 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$174 to $257
FacilityA hospital or hospital-owned outpatient department$204$170 to $204

How much rates vary

Facilitymedian $204 · 10th to 90th $170 to $295Professionalmedian $214 · 10th to 90th $151 to $347
$100$200$500facility $204professional $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
$169.82
Median
$204.17
Typical High
$204.17
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$263.03
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$213.80
Typical High
$338.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$154.88
Median
$257.04
Typical High
$575.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$263.03
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$229.09
Typical High
$316.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$426.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$229.09
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$223.87
Typical High
$371.54
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$89.13
Typical High
$478.63

Where Rhode Island 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.

Rhode Island· 26th of 51

$214

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.