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Established Patient Office Visit, High Complexity

Idaho 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?

$182

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $182 for this service. The price depends on where it is billed: about $182 from a physician practice, and about $178 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$182$132 to $275
FacilityA hospital or hospital-owned outpatient department$178$123 to $229

How much rates vary

Facilitymedian $178 · 10th to 90th $81 to $282Professionalmedian $182 · 10th to 90th $102 to $468
$50$100$200$500facility $178professional $182

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
$61.66
Median
$199.53
Typical High
$269.15
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$16.22
Median
$41.69
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$177.83
Typical High
$478.63
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$223.87
Typical High
$537.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$288.40
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$194.98
Typical High
$309.03
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$288.40
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$251.19
Typical High
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$354.81
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$371.54
Select Health
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$69.18
Typical High
$186.21
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$223.87
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$177.83
Typical High
$288.40
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$83.18
Median
$89.13
Typical High
$338.84

Where Idaho 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.

Idaho· 8th of 51

$182

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.