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Office Visit, Established Patient (Low Complexity)

New Jersey 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?

$79.43

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $79.43 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $70.79 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$79.43$61.66 to $105
FacilityA hospital or hospital-owned outpatient department$70.79$45.71 to $178

How much rates vary

Facilitymedian $71 · 10th to 90th $38 to $309Professionalmedian $79 · 10th to 90th $48 to $170
$20$50$100$200$500facility $71professional $79

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
$70.79
Typical High
$309.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$338.84
Median
$436.52
Typical High
$602.56
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
$91.20
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$85.11
Typical High
$123.03
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$91.20
Typical High
$131.83
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$114.82
Typical High
$5,888.44
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$74.13
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$173.78
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$83.18
Typical High
$147.91
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$44.67
Typical High
$147.91
Emblem Health
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$87.10
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$69.18
Typical High
$151.36
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$95.50
Typical High
$138.04

Where New Jersey 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.

New Jersey· 32nd of 51

$79.43

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.