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Established Patient Office Visit, High Complexity

New Mexico 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 New Mexico, 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 $162 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$162$129 to $224
FacilityA hospital or hospital-owned outpatient department$162$132 to $200

How much rates vary

Facilitymedian $162 · 10th to 90th $112 to $269Professionalmedian $162 · 10th to 90th $107 to $380
$50$100$200$500facility $162professional $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
$123.03
Median
$144.54
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$407.38
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$117.49
Median
$229.09
Typical High
$549.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$154.88
Typical High
$234.42
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$123.03
Median
$169.82
Typical High
$218.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$147.91
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$147.91
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$281.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$162.18
Typical High
$275.42
Providence
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$154.88
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$288.40
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$95.50
Typical High
$346.74

Where New Mexico 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 Mexico· 23rd 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.