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Office Visit, Established Patient (Straightforward)

Vermont rates for HCPCS 99212

A brief follow-up appointment with a doctor or other provider the patient has seen before, used for simple, low-complexity issues that don't require much evaluation or decision-making. It's the most basic level of an established-patient office visit, often used for minor concerns or quick check-ins. Visit length and content are limited compared to visits addressing more involved problems.

Rates data updated July 2026.

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

$56.23

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $56.23 for this service. The price depends on where it is billed: about $56.23 from a physician practice, and about $40.74 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 5 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$56.23$43.65 to $77.62
FacilityA hospital or hospital-owned outpatient department$40.74$32.36 to $69.18

How much rates vary

Facilitymedian $41 · 10th to 90th $25 to $170Professionalmedian $56 · 10th to 90th $32 to $155
$10$20$50$100$200facility $41professional $56

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$40.74
Typical High
$169.82
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$281.84
Median
$281.84
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$56.23
Typical High
$154.88
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$45.71
Median
$67.61
Typical High
$162.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$74.13
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$47.86
Typical High
$75.86
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$60.26
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$20.89
Median
$32.36
Typical High
$69.18
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$60.26
Typical High
$134.90

Where Vermont 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.

Vermont· 5th of 51

$56.23

MN $63.10DC $38.90

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.