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Office Visit, Established Patient (Straightforward)

Kentucky rates for HCPCS 99212

A brief follow-up appointment with a doctor or other provider the patient has seen before, used for simple, low-complexity issues that don't require much evaluation or decision-making. It's the most basic level of an established-patient office visit, often used for minor concerns or quick check-ins. Visit length and content are limited compared to visits addressing more involved problems.

Rates data updated July 2026.

How much does Office Visit, Established Patient (Straightforward) cost?

$47.86

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $47.86 for this service. The price depends on where it is billed: about $47.86 from a physician practice, and about $35.48 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$47.86$35.48 to $69.18
FacilityA hospital or hospital-owned outpatient department$35.48$30.20 to $46.77

How much rates vary

Facilitymedian $35 · 10th to 90th $23 to $62Professionalmedian $48 · 10th to 90th $26 to $105
$20$50$100$200$500facility $35professional $48

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
$22.91
Median
$35.48
Typical High
$64.57
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$331.13
Typical High
$512.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$48.98
Typical High
$109.65
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$36.31
Median
$61.66
Typical High
$151.36
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$52.48
Typical High
$72.44
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$42.66
Median
$54.95
Typical High
$74.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$36.31
Typical High
$52.48
Anthem BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
CareSource
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$36.31
Typical High
$48.98
CareSource
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$56.23
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$50.12
Typical High
$50.12
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Cigna
Setting
Facility
Modifier
62 · Two surgeons
Typical Low
$31.62
Median
$31.62
Typical High
$31.62
Cigna
Setting
Facility
Modifier
AS · PA/NP assist
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$47.86
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$32.36
Typical High
$77.62
United
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$69.18
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$38.90
Typical High
$77.62
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$89.13

Where Kentucky sits

The same service costs 1.6 times more in Minnesota than in Washington, DC. 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.

Kentucky· 28th of 51

$47.86

MN $63.10DC $38.90

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.