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Established Patient Office Visit, High Complexity

Maine rates for HCPCS 99215

This is the most involved type of office visit for a patient who has already been seen by that practice, used when the medical decision-making is complex, such as managing multiple serious conditions or higher-risk treatment decisions. It reflects a high degree of complexity in the medical decisions made, or a longer amount of time spent with the patient during that visit. It differs from more routine follow-up visits mainly by that greater complexity or time.

Rates data updated July 2026.

How much does Established Patient Office Visit, High Complexity cost?

$145

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $126 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$145$117 to $195
FacilityA hospital or hospital-owned outpatient department$126$97.72 to $148

How much rates vary

Facilitymedian $126 · 10th to 90th $72 to $776Professionalmedian $145 · 10th to 90th $95 to $309
$50$200$1K$5K$20Kfacility $126professional $145

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
$72.44
Median
$125.89
Typical High
$645.65
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$199.53
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$128.82
Typical High
$181.97
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$245.47
Typical High
$245.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$190.55
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$338.84
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$263.03
Typical High
$354.81
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$467.74
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$128.82
Typical High
$831.76
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$229.09
Typical High
$338.84
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$128.82
Typical High
$245.47
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$245.47
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$213.80
Typical High
$363.08
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$95.50
Typical High
$346.74

Where Maine sits

The same service costs 1.8 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· 42nd of 51

$145

MN $219DC $123

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.