How Much Does Office visit - established patient, low complexity Cost?
Office visit - established patient, low complexity (CPT 99213) costs $67 at Medicare rates.
Office visit - established patient, low complexity Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $91 | $136 — $227 |
| AL — ALABAMA | $65 | $97 — $162 |
| AR — ARKANSAS | $64 | $96 — $161 |
| AZ — ARIZONA | $68 | $102 — $170 |
| AZ — Phoenix | $69 | $103 — $172 |
| CA — BAKERSFIELD | $71 | $106 — $177 |
| CA — CHICO | $70 | $105 — $176 |
| CA — EL CENTRO | $70 | $105 — $176 |
| CA — FRESNO | $70 | $105 — $176 |
| CA — HANFORD-CORCORAN | $70 | $105 — $176 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $74 | $111 — $184 |
| CA — Los Angeles | $75 | $112 — $186 |
| CA — MADERA | $70 | $105 — $176 |
| CA — MERCED | $70 | $105 — $176 |
| CA — MODESTO | $70 | $105 — $176 |
| CA — NAPA | $77 | $116 — $193 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $73 | $109 — $182 |
| CA — REDDING | $70 | $105 — $176 |
| CA — REST OF CALIFORNIA | $70 | $105 — $176 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $72 | $107 — $179 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $73 | $109 — $181 |
| CA — SALINAS | $72 | $108 — $181 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $73 | $110 — $183 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $80 | $120 — $201 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $81 | $122 — $204 |
How to Reduce Your Cost for Office visit - established patient, low complexity
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($103) differs from the facility rate ($67). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Medicare rates for this procedure range from $55 to $91 depending on location. Commercial rates vary even more.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU () x CF ($33.40) = N/A
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Office visit - established patient, low complexity cost?
The Medicare facility rate for Office visit - established patient, low complexity is $67. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Office visit - established patient, low complexity cost without insurance?
Without insurance, the cost of Office visit - established patient, low complexity can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Office visit - established patient, low complexity?
Most commercial health insurance plans and Medicare cover Office visit - established patient, low complexity when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.