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Established Patient Office Visit, High Complexity

Utah 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?

$174

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $355 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$174$126 to $240
FacilityA hospital or hospital-owned outpatient department$355$148 to $380

How much rates vary

Facilitymedian $355 · 10th to 90th $120 to $380Professionalmedian $174 · 10th to 90th $63 to $437
$50$100$200$500facility $355professional $174

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
$120.23
Median
$354.81
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$173.78
Typical High
$436.52
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$186.21
Typical High
$457.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$165.96
Typical High
$309.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$199.53
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$269.15
Select Health
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$199.53
Select Health
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$407.38
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$151.36
Typical High
$251.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$89.13

Where Utah 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.

Utah· 13th of 51

$174

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.