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Vermont rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $115 · 10th–90th $102–$2510%50%10th90th$115Professionalmedian $195 · 10th–90th $135–$2750%20%10th90th$195$0.0$0.2$2.0$20.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $114.82 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $190.55 / $269.15
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $389.05 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $251.19 / $380.19
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $194.98 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $257.04 / $467.74