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Office Visit, Established Patient (Low Complexity)

South Dakota 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 South Dakota, 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 $195 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$63.10 to $120
FacilityA hospital or hospital-owned outpatient department$195$87.10 to $437

How much rates vary

Facilitymedian $195 · 10th to 90th $55 to $537Professionalmedian $83 · 10th to 90th $54 to $229
$20$50$100$200$500facility $195professional $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
$63.10
Median
$208.93
Typical High
$537.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$190.55
Median
$295.12
Typical High
$602.56
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$81.28
Typical High
$229.09
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$89.13
Typical High
$229.09
Avera
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$91.20
Typical High
$107.15
Avera
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$117.49
Typical High
$199.53
Medica
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$81.28
Typical High
$147.91
Medica
Setting
Facility
Modifier
62 · Two surgeons
Typical Low
$151.36
Median
$151.36
Typical High
$186.21
Medica
Setting
Facility
Modifier
AS · PA/NP assist
Typical Low
$23.99
Median
$23.99
Typical High
$29.51
Medica
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$138.04
Typical High
$416.87
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$100.00
Median
$134.90
Typical High
$199.53
Midlands
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$128.82
Typical High
$177.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$162.18
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$91.20
Typical High
$165.96
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$95.50
Typical High
$144.54
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$87.10
Typical High
$144.54

Where South Dakota 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.

South Dakota· 28th 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.