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Specialist Office Consultation

Vermont rates for HCPCS 99243

This service covers an office visit where a specialist reviews a patient's specific health problem at the request of another treating clinician and provides an opinion or recommendation. It involves a detailed review of the person's history and a focused examination, along with medical decision-making of low complexity. A written report is typically sent back to the requesting clinician.

Rates data updated July 2026.

How much does Specialist Office Consultation cost?

$126

Typical physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $102 to $155.

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.

How much rates vary

Facilitymedian $107 · 10th to 90th $102 to $138Professionalmedian $126 · 10th to 90th $79 to $363
$10$20$50$100$200$500facility $107professional $126

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
$102.33
Median
$107.15
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$123.03
Typical High
$380.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$213.80
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$204.17
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.03
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$104.71
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$138.04
Typical High
$281.84

Where Vermont sits

Rates are fairly even across states for this service. 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

$126

MN $145WV $97.72

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.