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Office Visit, New Patient (High Complexity)

West 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?

$195

Typical negotiated rate. In West Virginia, 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 $178 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 5 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 $324
FacilityA hospital or hospital-owned outpatient department$178$155 to $200

How much rates vary

Facilitymedian $178 · 10th to 90th $148 to $229Professionalmedian $195 · 10th to 90th $129 to $398
$50$100$200$500facility $178professional $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
$117.49
Median
$177.83
Typical High
$208.93
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$398.11
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$354.81
Typical High
$467.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$234.42
CareSource
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$218.78
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$223.87
Typical High
$1,148.15
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$234.42
Typical High
$309.03
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$218.78
Median
$239.88
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$331.13
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$269.15

Where West 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.

West Virginia· 41st 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.