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Office Visit, Established Patient (Low Complexity)

North Carolina 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 North Carolina, 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 $89.13 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$85.11$64.57 to $115
FacilityA hospital or hospital-owned outpatient department$89.13$66.07 to $126

How much rates vary

Facilitymedian $89 · 10th to 90th $51 to $204Professionalmedian $85 · 10th to 90th $49 to $178
$20$50$100$200facility $89professional $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
$51.29
Median
$102.33
Typical High
$245.47
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$74.13
Median
$169.82
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$85.11
Typical High
$181.97
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$53.70
Median
$87.10
Typical High
$194.98
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$85.11
Typical High
$128.82
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$69.18
Median
$91.20
Typical High
$134.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$95.50
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$151.36
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
$83.18
Typical High
$147.91
Medcost
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$75.86
Typical High
$169.82
Medcost
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$81.28
Typical High
$125.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$186.21
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$107.15
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$70.79
Typical High
$125.89
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$91.20
Typical High
$141.25
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Facility
Modifier
62 · Two surgeons
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Wellcare
Setting
Facility
Modifier
AS · PA/NP assist
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34

Where North Carolina 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.

North Carolina· 19th 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.