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Established Patient Office Visit, High Complexity

Missouri 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?

$162

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $162 for this service. The price depends on where it is billed: about $162 from a physician practice, and about $166 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$162$123 to $224
FacilityA hospital or hospital-owned outpatient department$166$126 to $251

How much rates vary

Facilitymedian $166 · 10th to 90th $110 to $513Professionalmedian $162 · 10th to 90th $95 to $363
$50$100$200$500$1K$2Kfacility $166professional $162

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
$112.20
Median
$177.83
Typical High
$2,884.03
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$457.09
Median
$467.74
Typical High
$933.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$162.18
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$218.78
Typical High
$524.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$151.36
Median
$186.21
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$144.54
Typical High
$208.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$177.83
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$275.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$288.40
Medica
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$630.96
Median
$630.96
Typical High
$707.95
Medica
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$194.98
Typical High
$1,122.02
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$154.88
Median
$213.80
Typical High
$302.00
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$269.15
Qualchoice
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$199.53
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$141.25
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$141.25
Typical High
$269.15
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$95.50
Typical High
$407.38

Where Missouri 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.

Missouri· 25th of 51

$162

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.