Established patient office or other outpatient visit, 40-54 minutes
Medicare pricing data for 417,696 providers across 52 states
This is one of the most commonly performed procedures in Medicare, with 12.1 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Established patient office or other outpatient visit, 40-54 minutes (HCPCS code 99215) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $163.05, but hospitals typically charge $383.55 — a 2.4x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $163.05, your out-of-pocket cost would be approximately $32.61. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.4x more than what Medicare allows for this procedure. Medicare actually pays $120.04 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $208 | $507 | 1,102 | 32,037 | +27.3% |
| New Jersey | $183 | $415 | 10,311 | 352,760 | +12.2% |
| New York | $181 | $534 | 25,517 | 677,477 | +11.0% |
| District of Columbia | $180 | $351 | 1,673 | 64,653 | +10.5% |
| California | $180 | $455 | 36,907 | 1,733,806 | +10.3% |
| Connecticut | $171 | $378 | 5,844 | 111,708 | +4.9% |
| Florida | $168 | $373 | 23,664 | 783,508 | +3.3% |
| Maryland | $168 | $347 | 10,325 | 384,910 | +3.3% |
| Hawaii | $167 | $339 | 1,224 | 37,490 | +2.4% |
| Illinois | $167 | $362 | 17,014 | 550,076 | +2.3% |
| Delaware | $166 | $347 | 1,525 | 54,564 | +1.9% |
| Nevada | $166 | $368 | 2,464 | 86,454 | +1.8% |
| Wyoming | $165 | $367 | 601 | 16,871 | +1.1% |
| Massachusetts | $164 | $524 | 15,846 | 504,124 | +0.3% |
| Georgia | $163 | $390 | 10,237 | 236,112 | -0.3% |
| Virginia | $163 | $332 | 11,049 | 347,298 | -0.3% |
| Washington | $162 | $388 | 11,312 | 332,662 | -0.7% |
| Texas | $161 | $365 | 25,217 | 741,147 | -1.3% |
| Arizona | $161 | $334 | 8,786 | 346,958 | -1.3% |
| Pennsylvania | $160 | $320 | 21,012 | 574,208 | -2.0% |
| South Carolina | $158 | $303 | 6,345 | 202,895 | -3.4% |
| Minnesota | $155 | $481 | 11,324 | 237,635 | -4.8% |
| Puerto Rico | $155 | $208 | 261 | 3,542 | -5.2% |
| Indiana | $154 | $283 | 8,536 | 190,987 | -5.7% |
| Alabama | $154 | $265 | 5,339 | 135,960 | -5.8% |
| Rhode Island | $153 | $371 | 1,587 | 28,187 | -6.4% |
| North Carolina | $152 | $348 | 15,678 | 430,246 | -6.5% |
| Colorado | $152 | $410 | 9,385 | 258,927 | -6.7% |
| New Mexico | $152 | $302 | 2,587 | 73,994 | -6.7% |
| Louisiana | $152 | $303 | 5,757 | 136,951 | -7.0% |
| Michigan | $151 | $261 | 15,414 | 278,405 | -7.4% |
| Tennessee | $151 | $344 | 8,641 | 223,789 | -7.5% |
| New Hampshire | $151 | $336 | 2,902 | 73,210 | -7.7% |
| Missouri | $150 | $312 | 7,477 | 160,042 | -8.1% |
| Mississippi | $149 | $259 | 2,795 | 80,947 | -8.4% |
| Oregon | $149 | $438 | 6,107 | 153,020 | -8.5% |
| Kentucky | $149 | $308 | 4,868 | 94,525 | -8.8% |
| Oklahoma | $147 | $317 | 3,872 | 109,950 | -9.9% |
| Utah | $147 | $303 | 3,957 | 93,418 | -9.9% |
| Ohio | $147 | $342 | 17,211 | 319,890 | -10.1% |
| Arkansas | $146 | $283 | 2,790 | 76,743 | -10.2% |
| Nebraska | $145 | $363 | 2,892 | 67,912 | -10.9% |
| Wisconsin | $145 | $457 | 9,605 | 222,277 | -11.0% |
| West Virginia | $145 | $303 | 1,929 | 34,988 | -11.3% |
| Vermont | $144 | $253 | 1,054 | 30,986 | -11.7% |
| Iowa | $143 | $349 | 4,039 | 84,944 | -12.5% |
| Kansas | $142 | $266 | 3,685 | 118,676 | -12.6% |
| Montana | $142 | $312 | 1,911 | 65,132 | -12.8% |
| South Dakota | $141 | $271 | 1,377 | 35,674 | -13.6% |
| Idaho | $137 | $288 | 2,499 | 59,804 | -16.3% |
| North Dakota | $136 | $301 | 1,410 | 37,062 | -16.5% |
| Maine | $134 | $302 | 2,640 | 44,728 | -17.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber