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Office Visit, Established Patient (Moderate Complexity)

South 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?

$102

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $102 for this service. The price depends on where it is billed: about $102 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$102$79.43 to $148
FacilityA hospital or hospital-owned outpatient department$117$89.13 to $162

How much rates vary

Facilitymedian $117 · 10th to 90th $76 to $214Professionalmedian $102 · 10th to 90th $47 to $234
$20$50$100$200$500facility $117professional $102

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
$75.86
Median
$125.89
Typical High
$218.78
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$57.54
Median
$177.83
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$102.33
Typical High
$234.42
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$48.98
Median
$109.65
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$128.82
Typical High
$190.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$144.54
Typical High
$363.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$194.98
Medcost
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$123.03
Medcost
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$186.21
Medcost
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$93.33
Typical High
$158.49
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$181.97

Where South 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.

South Carolina· 45th of 51

$102

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.