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Office Visit, Established Patient (Moderate Complexity)

South Dakota 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?

$115

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $115 from a physician practice, and about $135 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$115$89.13 to $182
FacilityA hospital or hospital-owned outpatient department$135$64.57 to $224

How much rates vary

Facilitymedian $135 · 10th to 90th $46 to $437Professionalmedian $115 · 10th to 90th $69 to $331
$20$50$100$200$500facility $135professional $115

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
$134.90
Typical High
$436.52
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$245.47
Typical High
$891.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$331.13
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$120.23
Typical High
$338.84
Avera
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$134.90
Typical High
$158.49
Avera
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$144.54
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$173.78
Typical High
$288.40
Medica
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$117.49
Typical High
$208.93
Medica
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$602.56
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$204.17
Typical High
$316.23
Midlands
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$251.19
Midlands
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$165.96
Typical High
$239.88
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$165.96
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$131.83
Typical High
$239.88
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$158.49
Typical High
$204.17
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$128.82
Typical High
$204.17

Where South Dakota 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 Dakota· 28th of 51

$115

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.