go back

Established Patient Office Visit, High Complexity

Rhode Island 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?

$155

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $155 for this service. The price depends on where it is billed: about $155 from a physician practice, and about $145 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 4 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$155$123 to $200
FacilityA hospital or hospital-owned outpatient department$145$110 to $240

How much rates vary

Facilitymedian $145 · 10th to 90th $110 to $389Professionalmedian $155 · 10th to 90th $100 to $282
$50$100$200$500facility $145professional $155

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
$109.65
Median
$144.54
Typical High
$398.11
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$208.93
Median
$446.68
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$154.88
Typical High
$281.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$40.74
Median
$177.83
Typical High
$446.68
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$194.98
Typical High
$371.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$173.78
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$173.78
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$323.59
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$281.84
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$338.84

Where Rhode Island 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.

Rhode Island· 30th of 51

$155

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.