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Established Patient Office Visit, High Complexity

Ohio 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 Ohio, 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 $115 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 11 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$115 to $204
FacilityA hospital or hospital-owned outpatient department$115$47.86 to $155

How much rates vary

Facilitymedian $115 · 10th to 90th $46 to $195Professionalmedian $148 · 10th to 90th $95 to $309
$50$100$200$500facility $115professional $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
$45.71
Median
$112.20
Typical High
$194.98
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$42.66
Median
$47.86
Typical High
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$147.91
Typical High
$316.23
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$97.72
Median
$204.17
Typical High
$457.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$173.78
Typical High
$239.88
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$181.97
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$131.83
Typical High
$218.78
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$186.21
Typical High
$275.42
CareSource
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$186.21
CareSource
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$181.97
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$302.00
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$128.82
Typical High
$223.87
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$281.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$104.71
Optum
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$165.96
Typical High
$288.40
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$194.98
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$144.54
Typical High
$302.00
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$239.88

Where Ohio 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.

Ohio· 32nd 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.