go back

Office Visit, New Patient (High Complexity)

Maine rates for HCPCS 99205

An initial, in-depth appointment with a doctor or provider the patient has not seen before, involving a high level of medical decision-making, such as managing multiple serious conditions or health issues that carry significant risk. It's the most involved level of a first-time office visit and typically takes considerably more time than a routine new-patient appointment. It reflects the most complex end of new-patient evaluations.

Rates data updated July 2026.

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

$204

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $182 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$204$166 to $269
FacilityA hospital or hospital-owned outpatient department$182$158 to $214

How much rates vary

Facilitymedian $182 · 10th to 90th $148 to $955Professionalmedian $204 · 10th to 90th $148 to $407
$100$1K$10Kfacility $182professional $204

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
$147.91
Median
$181.97
Typical High
$954.99
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$263.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$218.78
Typical High
$436.52
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$338.84
Typical High
$457.09
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$323.59
Typical High
$588.84
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$977.24
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$181.97
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$288.40
Typical High
$478.63
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$89.13
Typical High
$295.12

Where Maine sits

The same service costs 1.7 times more in Minnesota than in Delaware. 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· 34th of 51

$204

MN $295DE $174

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.