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Established Patient Office Visit, High Complexity

North Carolina 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?

$166

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $174 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$166$123 to $240
FacilityA hospital or hospital-owned outpatient department$174$141 to $224

How much rates vary

Facilitymedian $174 · 10th to 90th $115 to $316Professionalmedian $166 · 10th to 90th $65 to $355
$50$100$200$500facility $174professional $166

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
$117.49
Median
$190.55
Typical High
$354.81
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$43.65
Median
$223.87
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$154.88
Typical High
$371.54
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$72.44
Median
$181.97
Typical High
$416.87
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$181.97
Typical High
$275.42
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$186.21
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$204.17
Typical High
$346.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$302.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$154.88
Typical High
$338.84
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$263.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$363.08
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$223.87
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$147.91
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$138.04
Typical High
$263.03
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$346.74
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02

Where North Carolina 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.

North Carolina· 17th of 51

$166

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.