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Preventive Visit, Established Patient, Age 65+

Maine rates for HCPCS 99397

This is a routine preventive checkup for an established patient age 65 or older, focused on prevention rather than a specific complaint. It typically includes a physical exam, review of medications and chronic conditions, and screening recommendations appropriate for the patient's age.

Rates data updated July 2026.

How much does Preventive Visit, Established Patient, Age 65+ cost?

$135

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $135 for this service. The price depends on where it is billed: about $135 from a physician practice, and about $12,023 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$135$102 to $191
FacilityA hospital or hospital-owned outpatient department$12,023$457 to $19,953

How much rates vary

Facilitymedian $12,023 · 10th to 90th $110 to $19,953Professionalmedian $135 · 10th to 90th $83 to $275
$100$500$2K$10Kfacility $12,023professional $135

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
$109.65
Median
$12,022.64
Typical High
$19,952.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$186.21
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$144.54
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$263.03
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$269.15
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$177.83
Typical High
$331.13
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$12,022.64
Typical High
$19,952.62
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$169.82
Typical High
$281.84

Where Maine sits

The same service costs 2.1 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· 21st of 51

$135

MN $224DE $107

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.