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Office Visit, Established Patient (Moderate Complexity)

Virginia 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?

$107

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $107 for this service. The price depends on where it is billed: about $107 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 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$107$81.28 to $148
FacilityA hospital or hospital-owned outpatient department$107$81.28 to $138

How much rates vary

Facilitymedian $107 · 10th to 90th $68 to $191Professionalmedian $107 · 10th to 90th $60 to $214
$20$50$100$200$500facility $107professional $107

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
$60.26
Median
$91.20
Typical High
$263.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$147.91
Typical High
$204.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$107.15
Typical High
$208.93
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$52.48
Median
$117.49
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$144.54
Typical High
$234.42
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$75.86
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$117.49
Typical High
$199.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$151.36
Typical High
$229.09
Medcost
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$154.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$190.55
Medcost
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$186.21
Sentara
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$158.49
Sentara
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$102.33
Typical High
$194.98
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$128.82
Typical High
$199.53

Where Virginia 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.

Virginia· 36th of 51

$107

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.