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Office Visit, Established Patient (Low Complexity)

Georgia rates for HCPCS 99213

A standard follow-up appointment with a doctor or other provider the patient has seen before, used for common, everyday medical concerns that require some evaluation and decision-making but aren't highly complex. It's one of the most frequently used visit levels for routine follow-ups, such as checking on a stable chronic condition or addressing a new but uncomplicated symptom. It sits between the most basic and more complex visit levels.

Rates data updated July 2026.

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

$83.18

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $95.50 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$83.18$64.57 to $102
FacilityA hospital or hospital-owned outpatient department$95.50$61.66 to $282

How much rates vary

Facilitymedian $95 · 10th to 90th $54 to $417Professionalmedian $83 · 10th to 90th $52 to $174
$20$50$100$200$500facility $95professional $83

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
$53.70
Median
$93.33
Typical High
$446.68
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$257.04
Median
$398.11
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$83.18
Typical High
$173.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$56.23
Median
$87.10
Typical High
$181.97
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$91.20
Typical High
$141.25
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$69.18
Median
$93.33
Typical High
$151.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$74.13
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
CareSource
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$79.43
Typical High
$89.13
CareSource
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$79.43
Typical High
$141.25
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$100.00
Typical High
$169.82
Kaiser Permanente
Setting
Professional
Modifier
22 · Increased work
Typical Low
$169.82
Median
$213.80
Typical High
$302.00
Kaiser Permanente
Setting
Professional
Modifier
62 · Two surgeons
Typical Low
$52.48
Median
$67.61
Typical High
$93.33
Kaiser Permanente
Setting
Professional
Modifier
80 · Assistant surgeon
Typical Low
$4.47
Median
$5.75
Typical High
$7.94
Kaiser Permanente
Setting
Professional
Modifier
AS · PA/NP assist
Typical Low
$2.24
Median
$2.88
Typical High
$3.98
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$151.36
Typical High
$489.78
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$107.15
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$112.20
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$75.86
Typical High
$134.90
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$89.13
Typical High
$138.04

Where Georgia 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.

Georgia· 29th of 51

$83.18

MN $97.72DC $61.66

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.