Office Visit (Established, Moderate-High) Cost in Maryland
Office o/p est mod 30 min
$139.64Maryland physician fee2026 Medicare office rate- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
Maryland Medicare physician rate (2026)
+3.0% vs nationalAverage of 2 localities. Office range $136.67–$142.62.
Your ZIP in Maryland
A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
What office visit (established, moderate-high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Maryland moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. In Maryland the office and hospital physician lines for this CPT differ by $53.27.
National vs Maryland
Where Maryland ranks for this CPT
CPT 99214 by Maryland locality
| Locality | Office |
|---|---|
| baltimore/surr. cntys | $142.62 |
| rest of maryland | $136.67 |
PE GPCI ranges from 1.012 to 1.073 in Maryland. That index is why the same CPT is not one price statewide.
Office Visit (Established, Moderate-High) and how Maryland is priced
Maryland's Medicare physician pricing is split geographically: Baltimore and its surrounding counties form one locality, the rest of the state another, and, unusually, the Washington suburbs including Montgomery and Prince George's counties are priced inside the District of Columbia's high-cost locality rather than either Maryland one. That three-way carve means a Rockville procedure is approved at DC-area rates while an identical one in Frederick or Salisbury is not. Baltimore-area adjustments sit above rest-of-state levels but below the DC locality. Few states have their pricing shaped this much by a neighboring jurisdiction.
Maryland is also the only state with an all-payer rate-setting system for hospital services, so hospital-side billing works differently here than anywhere else in the country, though physician fees still follow the standard Medicare schedule. Baltimore's academic medical centers rank among the most prominent in the world and draw patients globally. The Eastern Shore and western Maryland are far more rural, with patients often traveling to Baltimore, Annapolis, or across state lines.
This procedure: This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Is Office Visit (Established, Moderate-High)?
This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Affects the Cost
- –It reimburses meaningfully more than 99213, and which of the two your visit becomes depends on documented complexity you cannot see from the waiting room.
- –Multi-condition patients land here repeatedly through the year, compounding the higher per-visit rate.
- –Facility fees at hospital-owned practices add a second charge to every visit at any level.
- –In-office tests, injections, or procedures stack as separate lines.
- –Specialist follow-ups at this level are priced above primary care equivalents in most charge masters.
Questions to Ask Before Booking
- 1.What determines whether my visit bills as level three or four, and what is the price difference for me?
- 2.During my deductible phase, what is the negotiated rate for this level here?
- 3.Will medication changes today push the visit to a higher level?
- 4.Are any of today's services billed separately from the visit code?
- 5.Can complex medication reviews be split across telehealth check-ins at lower cost?
Other featured procedures in Maryland
Office Visit (Established, Moderate-High) in other states
Office Visit (Established, Moderate-High) in Maryland: questions
The 2026 Medicare physician office rate for CPT 99214 averages $139.64 across 2 Maryland localities, from $136.67 in REST OF MARYLAND to $142.62 in BALTIMORE/SURR. CNTYS. The hospital physician rate averages $86.37. Enter a ZIP for the exact locality.
Yes. CMS splits Maryland into 2 payment localities. For this CPT the office physician fee spans $5.95 from the lowest to highest locality. A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $28 for the office physician line or $17 for the hospital physician line in Maryland. Medigap may cover that 20%. This is not the hospital facility fee.
No. $139.64 is the Medicare physician allowed amount for CPT 99214. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Maryland ranks #42 of 51 states on this physician line (3% above the national office rate of $135.61).