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Office Visit, Established Patient (Moderate Complexity)

Vermont rates for HCPCS 99214

A follow-up appointment with a doctor or other provider the patient has seen before, involving a moderate level of medical decision-making, such as managing several ongoing conditions or a condition that has changed and needs a closer look. It typically takes more time and involves more discussion and evaluation than a routine, simple check-in. The exact length varies, but it reflects a meaningful step up in complexity from the most basic follow-up visit.

Rates data updated July 2026.

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

$132

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $132 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $110 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$132$97.72 to $170
FacilityA hospital or hospital-owned outpatient department$110$81.28 to $158

How much rates vary

Facilitymedian $110 · 10th to 90th $72 to $380Professionalmedian $132 · 10th to 90th $60 to $282
$20$50$100$200$500facility $110professional $132

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
$74.13
Median
$109.65
Typical High
$380.19
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$398.11
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$131.83
Typical High
$281.84
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$37.15
Median
$134.90
Typical High
$380.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$169.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$199.53
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$72.44
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$123.03
Typical High
$269.15
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$154.88
Typical High
$181.97

Where Vermont sits

The same service costs 1.7 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· 7th of 51

$132

MN $148DC $89.13

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.