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Office Visit, Established Patient (Low Complexity)

West 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?

$79.43

Typical negotiated rate. In West Virginia, 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 $74.13 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 5 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 $110
FacilityA hospital or hospital-owned outpatient department$74.13$56.23 to $91.20

How much rates vary

Facilitymedian $74 · 10th to 90th $47 to $174Professionalmedian $79 · 10th to 90th $51 to $158
$10$20$50$100$200facility $74professional $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
$46.77
Median
$74.13
Typical High
$173.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$40.74
Median
$97.72
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$79.43
Typical High
$158.49
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$58.88
Median
$91.20
Typical High
$173.78
CareSource
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$69.18
Typical High
$83.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$89.13
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$134.90
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
$52.48
Median
$85.11
Typical High
$457.09
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$81.28
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$97.72
Typical High
$112.20
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$95.50
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$112.20
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$67.61
Typical High
$107.15
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$104.71
Typical High
$141.25

Where West 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.

West Virginia· 33rd 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.