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Office Visit, Established Patient (Low Complexity)

Utah 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?

$91.20

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $91.20 for this service. The price depends on where it is billed: about $91.20 from a physician practice, and about $100 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$91.20$67.61 to $117
FacilityA hospital or hospital-owned outpatient department$100$75.86 to $200

How much rates vary

Facilitymedian $100 · 10th to 90th $69 to $229Professionalmedian $91 · 10th to 90th $51 to $195
$10$20$50$100$200facility $100professional $91

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
$69.18
Median
$100.00
Typical High
$229.09
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$91.20
Typical High
$194.98
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$47.86
Median
$87.10
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$79.43
Typical High
$154.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$114.82
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$89.13
Typical High
$128.82
Select Health
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$102.33
Select Health
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$204.17
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$169.82
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$77.62
Typical High
$125.89
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$141.25

Where Utah 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.

Utah· 7th of 51

$91.20

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.