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Office Visit, New Patient (High Complexity)

Virginia 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 Virginia, 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 $214 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$209$166 to $282
FacilityA hospital or hospital-owned outpatient department$214$174 to $269

How much rates vary

Facilitymedian $214 · 10th to 90th $151 to $331Professionalmedian $209 · 10th to 90th $138 to $407
$50$100$200$500$1Kfacility $214professional $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
$141.25
Median
$190.55
Typical High
$269.15
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$177.83
Median
$275.42
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$204.17
Typical High
$407.38
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$251.19
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$416.87
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$151.36
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$223.87
Typical High
$371.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$263.03
Typical High
$371.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$223.87
Typical High
$295.12
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
$389.05
Sentara
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$323.59
Sentara
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$239.88
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$204.17
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$89.13
Typical High
$338.84

Where Virginia 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.

Virginia· 33rd 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.