go back

Office Visit, Established Patient (Low Complexity)

Maine rates for HCPCS 99213

A standard follow-up appointment with a doctor or other provider the patient has seen before, used for common, everyday medical concerns that require some evaluation and decision-making but aren't highly complex. It's one of the most frequently used visit levels for routine follow-ups, such as checking on a stable chronic condition or addressing a new but uncomplicated symptom. It sits between the most basic and more complex visit levels.

Rates data updated July 2026.

How much does Office Visit, Established Patient (Low Complexity) cost?

$74.13

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $77.62 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$74.13$58.88 to $97.72
FacilityA hospital or hospital-owned outpatient department$77.62$64.57 to $112

How much rates vary

Facilitymedian $78 · 10th to 90th $55 to $603Professionalmedian $74 · 10th to 90th $48 to $151
$50$200$1K$5Kfacility $78professional $74

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
$54.95
Median
$77.62
Typical High
$602.56
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$81.28
Median
$89.13
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$67.61
Typical High
$97.72
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$95.50
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$81.28
Typical High
$165.96
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$138.04
Typical High
$181.97
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$125.89
Typical High
$229.09
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$77.62
Typical High
$346.74
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$81.28
Median
$89.13
Typical High
$234.42
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$66.07
Typical High
$125.89
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$102.33
Typical High
$181.97
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$95.50
Typical High
$138.04

Where Maine sits

The same service costs 1.6 times more in Minnesota than in Washington, DC. 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· 47th of 51

$74.13

MN $97.72DC $61.66

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.