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Maine rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $245 · 10th–90th $48–$9330%10%20%10th90th$245Professionalmedian $219 · 10th–90th $141–$5130%10%20%10th90th$219$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $213.80 / $851.14
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$933.25 / $933.25 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $204.17 / $457.09
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $331.13 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $436.52
Community Health Options
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $338.84 / $457.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $331.13 / $588.84
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $181.97 / $22,387.21
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $190.55 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $281.84 / $457.09
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $89.13 / $295.12