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Office Visit, Established Patient (Low Complexity)

Virginia 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?

$77.62

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $77.62 from a physician practice, and about $72.44 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$77.62$60.26 to $100
FacilityA hospital or hospital-owned outpatient department$72.44$54.95 to $95.50

How much rates vary

Facilitymedian $72 · 10th to 90th $45 to $129Professionalmedian $78 · 10th to 90th $45 to $145
$20$50$100$200facility $72professional $78

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
$42.66
Median
$63.10
Typical High
$147.91
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$128.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$77.62
Typical High
$141.25
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$89.13
Typical High
$173.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$100.00
Typical High
$162.18
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$50.12
Typical High
$70.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$204.17
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
$79.43
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$107.15
Typical High
$158.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$104.71
Medcost
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$79.43
Typical High
$128.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$120.23
Sentara
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$63.10
Typical High
$107.15
Sentara
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$89.13
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$97.72
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$70.79
Typical High
$131.83
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$95.50
Typical High
$138.04

Where Virginia 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.

Virginia· 35th of 51

$77.62

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.