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Office Visit, Established Patient (Moderate Complexity)

Maine rates for HCPCS 99214

A follow-up appointment with a doctor or other provider the patient has seen before, involving a moderate level of medical decision-making, such as managing several ongoing conditions or a condition that has changed and needs a closer look. It typically takes more time and involves more discussion and evaluation than a routine, simple check-in. The exact length varies, but it reflects a meaningful step up in complexity from the most basic follow-up visit.

Rates data updated July 2026.

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

$102

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $102 for this service. The price depends on where it is billed: about $102 from a physician practice, and about $112 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$102$83.18 to $138
FacilityA hospital or hospital-owned outpatient department$112$89.13 to $148

How much rates vary

Facilitymedian $112 · 10th to 90th $69 to $589Professionalmedian $102 · 10th to 90th $68 to $214
$50$200$1K$5Kfacility $112professional $102

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
$69.18
Median
$112.20
Typical High
$588.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$54.95
Median
$114.82
Typical High
$354.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$95.50
Typical High
$138.04
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$77.62
Median
$81.28
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$134.90
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$117.49
Typical High
$245.47
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$257.04
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$173.78
Typical High
$331.13
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$645.65
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$54.95
Median
$114.82
Typical High
$354.81
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$95.50
Typical High
$169.82
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$77.62
Median
$81.28
Typical High
$95.50
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$151.36
Typical High
$257.04
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$165.96
Typical High
$251.19

Where Maine sits

The same service costs 1.7 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· 46th of 51

$102

MN $148DC $89.13

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.