go back

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.

Facilitymedian $229 · 10th–90th $72$7760%10%10th90th$229Professionalmedian $162 · 10th–90th $81$3630%10%20%10th90th$162$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
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$204.17
Typical High
$776.25
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$181.97
Median
$316.23
Typical High
$724.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$147.91
Typical High
$354.81
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$186.21
Typical High
$416.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
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
$151.36
Median
$251.19
Typical High
$467.74
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$128.82
Typical High
$17,782.79
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$141.25
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$199.53
Typical High
$363.08
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$95.50
Typical High
$346.74