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Office Visit, New Patient (High Complexity)

South 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?

$195

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $195 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $219 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$195$155 to $269
FacilityA hospital or hospital-owned outpatient department$219$174 to $275

How much rates vary

Facilitymedian $219 · 10th to 90th $145 to $339Professionalmedian $195 · 10th to 90th $129 to $447
$50$100$200$500$1Kfacility $219professional $195

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
$186.21
Typical High
$295.12
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$446.68
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$257.04
Typical High
$524.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$354.81
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$169.82
Median
$234.42
Typical High
$389.05
BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$275.42
Typical High
$645.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$147.91
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$213.80
Typical High
$363.08
Medcost
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$223.87
Typical High
$257.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$223.87
Typical High
$354.81
Medcost
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$302.00
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$91.20
Typical High
$478.63

Where South 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.

South Carolina· 42nd of 51

$195

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.