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Established Patient Office Visit, High Complexity

South Dakota 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.

Facilitymedian $224 · 10th–90th $69$5500%10%10th90th$224Professionalmedian $174 · 10th–90th $107$4270%5%10%10th90th$174$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$199.53
Typical High
$549.54
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$234.42
Median
$316.23
Typical High
$691.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$169.82
Typical High
$426.58
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$117.49
Median
$190.55
Typical High
$426.58
Avera
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$234.42
Avera
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$223.87
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$257.04
Typical High
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$309.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$1,122.02
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$281.84
Median
$363.08
Typical High
$467.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$275.42
Typical High
$346.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$323.59
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$234.42
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$177.83
Typical High
$323.59
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$223.87
Typical High
$281.84