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Office Visit, Established Patient (Moderate Complexity)

North Carolina rates for HCPCS 99214

A follow-up appointment with a doctor or other provider the patient has seen before, involving a moderate level of medical decision-making, such as managing several ongoing conditions or a condition that has changed and needs a closer look. It typically takes more time and involves more discussion and evaluation than a routine, simple check-in. The exact length varies, but it reflects a meaningful step up in complexity from the most basic follow-up visit.

Rates data updated July 2026.

How much does Office Visit, Established Patient (Moderate Complexity) cost?

$110

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $110 for this service. The price depends on where it is billed: about $110 from a physician practice, and about $123 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$110$81.28 to $166
FacilityA hospital or hospital-owned outpatient department$123$95.50 to $170

How much rates vary

Facilitymedian $123 · 10th to 90th $72 to $229Professionalmedian $110 · 10th to 90th $45 to $257
$20$50$100$200$500facility $123professional $110

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
$47.86
Median
$125.89
Typical High
$281.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$199.53
Typical High
$354.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$104.71
Typical High
$257.04
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$36.31
Median
$107.15
Typical High
$263.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$123.03
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$128.82
Typical High
$194.98
BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$144.54
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$123.03
Typical High
$213.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$114.82
Typical High
$239.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$186.21
Medcost
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$269.15
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$154.88
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$141.25
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$186.21
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$181.97
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33

Where North Carolina sits

The same service costs 1.7 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.

North Carolina· 32nd of 51

$110

MN $148DC $89.13

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.