Office visit, established patient (level 4) Cost

Office visit, established patient (level 4) is a clinic or emergency-department visit. Prices are from 2009 US hospitals across 52 states, from their machine-readable files.

Price comparison (median)

Lowest cash prices

CMS rating = overall hospital star rating (1–5); ER wait = median minutes in the emergency department; Readmit = 30-day readmission rate (lower is better) — all from Medicare’s Care Compare; “—” = not reported. Data last updated October 2026. Prices from hospitals’ machine-readable files (45 CFR §180); Medicare benchmark from CMS PFS/CLFS/IPPS. Prices below 15% of the median are excluded as likely partial or mis-coded charges. Estimates — confirm with the hospital. Report an incorrect price.

What insurers pay for Office visit, established patient (level 4)

Median in-network negotiated rate by insurer, across hospitals that publish it (cheapest first). Your actual rate depends on your specific plan and deductible. Cash / self-pay for comparison: $194; Medicare pays $136.

Negotiated rates are from hospitals’ machine-readable files (45 CFR §180); payer names are normalized to major brands, so a brand may span several plans. Estimates — confirm with your insurer.

Where it’s cheapest

Prices by city

Prices by state

Doctors who perform this

Clinicians who reported the most Medicare volume for this service. This reflects Original Medicare activity only and is a volume signal, not a quality ranking.

Does Medicare cover Office visit, established patient (level 4)?

Yes — Medicare generally covers Office visit, established patient (level 4). It is typically an outpatient service under Medicare Part B, with a Medicare-approved amount of about $136. After your annual Part B deductible, you typically owe the 20% coinsurance — roughly $27 — unless a Medicare Advantage or supplemental (Medigap) plan covers it.

General guidance from Medicare’s national rates — your actual coverage and share depend on medical necessity, your plan, and where the service is performed. Confirm with Medicare or your plan.

About these prices

Based on prices published by 2009 US hospitals across 52 states, the typical (median) cash price is $194, versus a chargemaster (list) price around $325, a median insurer-negotiated rate of $152, a Medicare rate of about $136. Most cash prices fall between $80 and $523 — a wide spread, which is exactly why comparing hospitals pays off.

How to save

• Ask each hospital for its cash / self-pay price — for shoppable services it is often far below the list price.
• Compare several nearby hospitals; prices for the same service can differ severalfold.
• Request a written estimate and the billing code (CPT/DRG) before scheduling.
• Use the Medicare benchmark above to judge whether a quote is reasonable.
• If you are uninsured, ask about financial assistance or prompt-pay discounts.

Frequently asked questions

Related Office & ER Visits

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