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Office Visit, New Patient (Moderate Complexity)

Maine rates for HCPCS 99204

An initial appointment with a doctor or provider the patient has not seen before, involving a moderate level of medical decision-making, such as reviewing several health concerns or evaluating a condition that needs a closer look. First visits like this typically involve more time than a follow-up because the provider is building a full picture of the patient's health history for the first time. It reflects a meaningful step up in complexity from the most basic new-patient visit.

Rates data updated July 2026.

Facilitymedian $158 · 10th–90th $112$7080%10%20%10th90th$158Professionalmedian $151 · 10th–90th $107$3020%20%10th90th$151$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$741.31
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$24.55
Median
$186.21
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$144.54
Typical High
$208.93
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$123.03
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$169.82
Typical High
$338.84
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$257.04
Typical High
$338.84
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$234.42
Typical High
$436.52
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$776.25
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$24.55
Median
$186.21
Typical High
$316.23
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$144.54
Typical High
$245.47
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$123.03
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$213.80
Typical High
$380.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$257.04
Typical High
$323.59