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Office Visit, Established Patient (Straightforward)

Virginia 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 Virginia, 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 $43.65 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$45.71$33.88 to $61.66
FacilityA hospital or hospital-owned outpatient department$43.65$30.90 to $56.23

How much rates vary

Facilitymedian $44 · 10th to 90th $25 to $87Professionalmedian $46 · 10th to 90th $25 to $87
$10$20$50$100$200facility $44professional $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
$23.44
Median
$41.69
Typical High
$120.23
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$52.48
Median
$107.15
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$44.67
Typical High
$83.18
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$30.20
Median
$57.54
Typical High
$102.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$58.88
Typical High
$100.00
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$26.30
Typical High
$38.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$141.25
Typical High
$204.17
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
$28.18
Median
$47.86
Typical High
$83.18
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$67.61
Typical High
$100.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$45.71
Typical High
$63.10
Medcost
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$46.77
Typical High
$81.28
Medcost
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$87.10
Sentara
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$33.88
Typical High
$57.54
Sentara
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$54.95
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$97.72
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$41.69
Typical High
$83.18
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$52.48
Median
$79.43
Typical High
$100.00

Where Virginia 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.

Virginia· 35th of 51

$45.71

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.