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Established Patient Office Visit, High Complexity

Vermont 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.

Rates data updated July 2026.

How much does Established Patient Office Visit, High Complexity cost?

$186

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $135 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$186$141 to $263
FacilityA hospital or hospital-owned outpatient department$135$105 to $186

How much rates vary

Facilitymedian $135 · 10th to 90th $105 to $200Professionalmedian $186 · 10th to 90th $91 to $490
$20$50$100$200$500facility $135professional $186

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
$104.71
Median
$134.90
Typical High
$199.53
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$186.21
Typical High
$489.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$245.47
Typical High
$630.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$234.42
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$162.18
Typical High
$269.15
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$199.53
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$104.71
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$162.18
Typical High
$363.08

Where Vermont sits

The same service costs 1.8 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

$186

MN $219DC $123

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.