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Office Visit, New Patient (High Complexity)

Tennessee 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?

$200

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $200 for this service. The price depends on where it is billed: about $200 from a physician practice, and about $191 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$200$166 to $263
FacilityA hospital or hospital-owned outpatient department$191$166 to $275

How much rates vary

Facilitymedian $191 · 10th to 90th $148 to $955Professionalmedian $200 · 10th to 90th $141 to $417
$50$100$200$500$1Kfacility $191professional $200

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
$147.91
Median
$173.78
Typical High
$371.54
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$218.78
Median
$218.78
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$416.87
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$169.82
Median
$281.84
Typical High
$724.44
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$223.87
Typical High
$316.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$234.42
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$218.78
Typical High
$354.81
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$1,380.38
Typical High
$1,380.38
Optum
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$223.87
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$204.17
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$346.74
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$213.80
Typical High
$457.09

Where Tennessee 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.

Tennessee· 38th of 51

$200

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.