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Office Visit, Established Patient (Low Complexity)

Kentucky 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?

$85.11

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $61.66 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$85.11$64.57 to $117
FacilityA hospital or hospital-owned outpatient department$61.66$54.95 to $77.62

How much rates vary

Facilitymedian $62 · 10th to 90th $45 to $363Professionalmedian $85 · 10th to 90th $49 to $186
$20$50$100$200$500facility $62professional $85

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
$43.65
Median
$58.88
Typical High
$398.11
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$204.17
Median
$549.54
Typical High
$691.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$87.10
Typical High
$194.98
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$57.54
Median
$91.20
Typical High
$239.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$81.28
Typical High
$117.49
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$67.61
Median
$89.13
Typical High
$120.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$60.26
Typical High
$89.13
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
$52.48
Median
$67.61
Typical High
$91.20
CareSource
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$91.20
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Cigna
Setting
Facility
Modifier
62 · Two surgeons
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Cigna
Setting
Facility
Modifier
AS · PA/NP assist
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$81.28
Typical High
$457.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$40.74
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$75.86
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$66.07
Typical High
$117.49
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$91.20
Typical High
$154.88

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· 22nd of 51

$85.11

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.