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Office Visit, Established Patient (Low Complexity)

Vermont rates for HCPCS 99213

A standard follow-up appointment with a doctor or other provider the patient has seen before, used for common, everyday medical concerns that require some evaluation and decision-making but aren't highly complex. It's one of the most frequently used visit levels for routine follow-ups, such as checking on a stable chronic condition or addressing a new but uncomplicated symptom. It sits between the most basic and more complex visit levels.

Rates data updated July 2026.

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

$91.20

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $91.20 for this service. The price depends on where it is billed: about $91.20 from a physician practice, and about $102 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$91.20$67.61 to $112
FacilityA hospital or hospital-owned outpatient department$102$56.23 to $186

How much rates vary

Facilitymedian $102 · 10th to 90th $46 to $447Professionalmedian $91 · 10th to 90th $48 to $204
$10$20$50$100$200$500facility $102professional $91

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
$50.12
Median
$102.33
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$91.20
Typical High
$204.17
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$95.50
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$120.23
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$77.62
Typical High
$131.83
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$45.71
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$87.10
Typical High
$218.78
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$104.71
Typical High
$128.82

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· 11th of 51

$91.20

MN $97.72DC $61.66

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.