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Established Patient Office Visit, High Complexity

Washington, DC rates for HCPCS 99215

This is the most involved type of office visit for a patient who has already been seen by that practice, used when the medical decision-making is complex, such as managing multiple serious conditions or higher-risk treatment decisions. It reflects a high degree of complexity in the medical decisions made, or a longer amount of time spent with the patient during that visit. It differs from more routine follow-up visits mainly by that greater complexity or time.

Rates data updated July 2026.

How much does Established Patient Office Visit, High Complexity cost?

$123

Typical negotiated rate. In Washington, DC, July 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $123 from a physician practice, and about $263 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 5 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$123$105 to $155
FacilityA hospital or hospital-owned outpatient department$263$204 to $347

How much rates vary

Facilitymedian $263 · 10th to 90th $123 to $363Professionalmedian $123 · 10th to 90th $81 to $204
$50$100$200$500facility $263professional $123

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
$123.03
Median
$263.03
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$123.03
Typical High
$190.55
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$33.88
Median
$154.88
Typical High
$257.04
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$114.82
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$309.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$213.80
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$162.18
Typical High
$309.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$323.59
Typical High
$346.74

Where Washington, DC sits

The same service costs 1.8 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.

Washington, DC· 51st of 51

$123

MN $219DC $123

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.