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Office Visit, Established Patient (Low Complexity)

Tennessee 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?

$75.86

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $93.33 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$75.86$60.26 to $95.50
FacilityA hospital or hospital-owned outpatient department$93.33$69.18 to $132

How much rates vary

Facilitymedian $93 · 10th to 90th $54 to $302Professionalmedian $76 · 10th to 90th $49 to $148
$20$50$100$200$500facility $93professional $76

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
$53.70
Median
$93.33
Typical High
$154.88
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$67.61
Median
$67.61
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$75.86
Typical High
$147.91
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$58.88
Median
$87.10
Typical High
$194.98
Aetna
Setting
Professional
Modifier
50 · Both sides
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$83.18
Typical High
$125.89
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$66.07
Median
$89.13
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$85.11
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$208.93
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
$51.29
Median
$75.86
Typical High
$128.82
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Lucent Health
Setting
Facility
Modifier
62 · Two surgeons
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Lucent Health
Setting
Facility
Modifier
AS · PA/NP assist
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$562.34
Typical High
$562.34
Optum
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$85.11
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$74.13
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$70.79
Typical High
$123.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$114.82

Where Tennessee 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.

Tennessee· 42nd of 51

$75.86

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.