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Established Patient Office Visit, High Complexity

New Jersey 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?

$148

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $148 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $120 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 7 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$148$117 to $214
FacilityA hospital or hospital-owned outpatient department$120$83.18 to $398

How much rates vary

Facilitymedian $120 · 10th to 90th $65 to $603Professionalmedian $148 · 10th to 90th $87 to $347
$50$100$200$500facility $120professional $148

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
$64.57
Median
$117.49
Typical High
$602.56
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$354.81
Typical High
$512.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$151.36
Typical High
$363.08
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$74.13
Median
$186.21
Typical High
$446.68
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$181.97
Typical High
$229.09
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$173.78
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$295.12
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$295.12
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$173.78
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$162.18
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$138.04
Typical High
$302.00
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$95.50
Typical High
$407.38

Where New Jersey 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.

New Jersey· 37th of 51

$148

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.