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Office Visit, Established Patient (Moderate Complexity)

Rhode Island 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?

$117

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $107 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 4 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$117$91.20 to $145
FacilityA hospital or hospital-owned outpatient department$107$77.62 to $178

How much rates vary

Facilitymedian $107 · 10th to 90th $78 to $316Professionalmedian $117 · 10th to 90th $69 to $229
$20$50$100$200$500facility $107professional $117

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
$77.62
Median
$107.15
Typical High
$316.23
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$117.49
Typical High
$229.09
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$37.15
Median
$125.89
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$141.25
Typical High
$218.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$120.23
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$173.78
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$128.82
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$114.82
Typical High
$186.21
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$204.17

Where Rhode Island 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.

Rhode Island· 26th of 51

$117

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.