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Office Visit, Established Patient (Low Complexity)

Maryland 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?

$81.28

Typical negotiated rate. In Maryland, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $158 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 6 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$81.28$60.26 to $105
FacilityA hospital or hospital-owned outpatient department$158$58.88 to $240

How much rates vary

Facilitymedian $158 · 10th to 90th $38 to $398Professionalmedian $81 · 10th to 90th $46 to $174
$20$50$100$200$500facility $158professional $81

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
$38.02
Median
$162.18
Typical High
$398.11
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$93.33
Median
$128.82
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$81.28
Typical High
$173.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$53.70
Median
$93.33
Typical High
$190.55
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$50.12
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$131.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$102.33
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$58.88
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$72.44
Typical High
$131.83
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$87.10
Median
$95.50
Typical High
$144.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$95.50
Typical High
$141.25

Where Maryland 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.

Maryland· 31st of 51

$81.28

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.