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Office Visit, Established Patient (Moderate Complexity)

New Mexico 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?

$120

Typical negotiated rate. In New Mexico, July 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $117 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$120$91.20 to $166
FacilityA hospital or hospital-owned outpatient department$117$95.50 to $145

How much rates vary

Facilitymedian $117 · 10th to 90th $79 to $191Professionalmedian $120 · 10th to 90th $72 to $263
$50$100$200$500facility $117professional $120

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
$89.13
Median
$114.82
Typical High
$154.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$275.42
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$134.90
Typical High
$346.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$102.33
Typical High
$151.36
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$117.49
Typical High
$165.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$147.91
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$123.03
Typical High
$181.97
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$199.53
Providence
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$199.53
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$134.90
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$151.36
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$123.03
Typical High
$204.17
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$138.04
Typical High
$199.53

Where New Mexico 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 Mexico· 21st of 51

$120

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.