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Office Visit, Established Patient (Moderate Complexity)

New Jersey 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?

$112

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $97.72 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$112$85.11 to $158
FacilityA hospital or hospital-owned outpatient department$97.72$56.23 to $204

How much rates vary

Facilitymedian $98 · 10th to 90th $46 to $437Professionalmedian $112 · 10th to 90th $63 to $263
$20$50$100$200$500facility $98professional $112

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
$45.71
Median
$91.20
Typical High
$436.52
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$125.89
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$114.82
Typical High
$263.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$120.23
Typical High
$275.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$173.78
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$83.18
Median
$128.82
Typical High
$173.78
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$6,025.60
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$107.15
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$173.78
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$123.03
Typical High
$213.80
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$46.77
Typical High
$208.93
Emblem Health
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$128.82
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$100.00
Typical High
$213.80
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$128.82
Typical High
$194.98

Where New Jersey 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.

New Jersey· 30th of 51

$112

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.