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Established Patient Office Visit, High Complexity

Tennessee 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 Tennessee, 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 $151 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$120 to $195
FacilityA hospital or hospital-owned outpatient department$151$123 to $204

How much rates vary

Facilitymedian $151 · 10th to 90th $112 to $912Professionalmedian $148 · 10th to 90th $102 to $302
$50$100$200$500$1Kfacility $151professional $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
$107.15
Median
$138.04
Typical High
$229.09
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$354.81
Median
$398.11
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$302.00
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$223.87
Typical High
$524.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$177.83
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$181.97
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$158.49
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$1,122.02
Typical High
$1,122.02
Optum
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$169.82
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$141.25
Typical High
$257.04
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$323.59

Where Tennessee 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.

Tennessee· 40th 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.