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Office Visit, Established Patient (Straightforward)

New Jersey 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?

$45.71

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $45.71 for this service. The price depends on where it is billed: about $45.71 from a physician practice, and about $48.98 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$45.71$34.67 to $63.10
FacilityA hospital or hospital-owned outpatient department$48.98$25.70 to $174

How much rates vary

Facilitymedian $49 · 10th to 90th $19 to $282Professionalmedian $46 · 10th to 90th $25 to $91
$10.0$20.0$50.0$100.0$200.0$500.0facility $49professional $46

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
$19.50
Median
$43.65
Typical High
$281.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$147.91
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$44.67
Typical High
$91.20
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$34.67
Median
$58.88
Typical High
$114.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$53.70
Typical High
$77.62
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$40.74
Median
$56.23
Typical High
$74.13
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$436.52
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$45.71
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$169.82
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$48.98
Typical High
$89.13
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$38.90
Typical High
$91.20
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$54.95
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$45.71
Typical High
$91.20
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$64.57
Median
$85.11
Typical High
$89.13

Where New Jersey sits

The same service costs 1.6 times more in Minnesota than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

New Jersey $45.71 · 34th of 51
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.