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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.

How much does Office Visit, New Patient (Moderate Complexity) cost?

$151

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $158 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$151$129 to $204
FacilityA hospital or hospital-owned outpatient department$158$138 to $282

How much rates vary

Facilitymedian $158 · 10th to 90th $112 to $741Professionalmedian $151 · 10th to 90th $107 to $302
$100$500$2K$10Kfacility $158professional $151

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Maine sits

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maine· 44th of 51

$151

MN $200DC $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.