Outpatient new patient office visit, high complexity

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC VISIT NEW PATIENT LEVEL 5

Payers reporting CPT 99205

Payer pricing summary

Low

$158

Average

$460

Median

$304

High

$4.2k

Payer rate distribution

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#
1	Ucare professional · fee schedule · outpatient · +19 other terms	32	$186	$186	$46	25%	1,376–1,394	$118 – $344
2	Blue Cross Blue Shield fee schedule · outpatient · +34 other terms	294	$323	$431	$316	73%	286–475	$0 – $3.1k
3	Aetna fee schedule · outpatient · +39 other terms	254	$212	$343	$577	168%	91–172	$1 – $8.4k
4	Oscar professional · fee schedule · outpatient · +21 other terms	21	$204	$211	$54	26%	80–89	$125 – $344
5	UnitedHealthcare fee schedule · outpatient · +44 other terms	301	$206	$364	$1.3k	359%	72–180	$1 – $24.3k
6	Regence professional · fee schedule · outpatient · +16 other terms	46	$196	$326	$159	49%	70–124	$125 – $684
7	Cigna fee schedule · outpatient · +34 other terms	175	$230	$234	$184	79%	68–113	$0 – $1.2k
8	Humana fee schedule · outpatient · +34 other terms	229	$209	$315	$523	166%	41–59	$1 – $8.3k
9	Bcbs Mt fee schedule · outpatient · +2 other terms	1	$412	$412	—	—	16	$412 – $412
10	Anthem fee schedule · outpatient · +30 other terms	115	$249	$376	$395	105%	14–23	$24 – $2.6k
11	Molina fee schedule · outpatient · +28 other terms	84	$157	$249	$416	167%	13–22	$1 – $3.0k
12	Ambetter fee schedule · both · +23 other terms	51	$303	$318	$86	27%	13	$80 – $657
13	Premera professional · fee schedule · outpatient · +11 other terms	19	$242	$251	$50	20%	7–70	$193 – $396
14	Optum professional · fee schedule · outpatient · +22 other terms	42	$192	$175	$50	29%	4–40	$88 – $243
15	Excellus professional · fee schedule · both · +14 other terms	22	$185	$193	$68	35%	3–30	$102 – $505
16	Caresource fee schedule · outpatient · +24 other terms	45	$171	$169	$71	42%	2–20	$1 – $561
17	Aetna Better Health fee schedule · outpatient · +20 other terms	44	$131	$139	$75	54%	1–10	$57 – $467
18	First Health fee schedule · outpatient · +21 other terms	36	$467	$528	$500	95%	1–10	$177 – $3.9k
19	Wellmark fee schedule · both · +24 other terms	29	$257	$243	$37	15%	1–10	$163 – $283
20	MultiPlan fee schedule · outpatient · +20 other terms	91	$593	$568	$396	70%	—	$27 – $3.9k
21	Kaiser fee schedule · outpatient · +24 other terms	60	$220	$263	$297	113%	—	$78 – $3.0k
22	WellCare fee schedule · both · +26 other terms	57	$167	$186	$32	17%	—	$132 – $238
23	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +2 other terms	49	$399	$543	$600	111%	—	$31 – $2.3k
24	Tricare facility · fee schedule · outpatient · +24 other terms	43	$158	$2.2k	$8.9k	404%	—	$59 – $50k
25	Highmark facility · fee schedule · outpatient · +19 other terms	39	$141	$296	$231	78%	—	$29 – $1.4k

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