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Established Patient Office Visit, High Complexity

West Virginia 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?

$145

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $126 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 5 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$145$115 to $240
FacilityA hospital or hospital-owned outpatient department$126$64.57 to $178

How much rates vary

Facilitymedian $126 · 10th to 90th $45 to $214Professionalmedian $145 · 10th to 90th $93 to $324
$50$100$200facility $126professional $145

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
$44.67
Median
$120.23
Typical High
$213.80
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$40.74
Median
$123.03
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$144.54
Typical High
$323.59
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$120.23
Median
$263.03
Typical High
$331.13
CareSource
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$181.97
CareSource
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$177.83
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$933.25
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$245.47
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$190.55
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$151.36
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$134.90
Typical High
$234.42
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$89.13
Typical High
$218.78

Where West Virginia 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.

West Virginia· 41st of 51

$145

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.