Commercial healthcare reimbursement in Vermont
How Vermont compares with the nation, by payer, specialty and procedure.
Vermont at a glance
What the data shows
Vermont ranks 18th of 51 states for commercial reimbursement, with an index of 107 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in Vermont run a median 157% of Medicare.
UnitedHealthcare has the highest index in the state (142) and Aetna the lowest (74), a 67-point gap, in the files analyzed.
CPT 64566 (Neuroeltrd stim post tibial) is the strongest relative to the national median (149% of it, a 49% premium); CPT 52000 (Cystourethroscopy) is furthest below (87% of the national median, 13% lower).
By specialty, Vermont is strongest for ophthalmology (ranks 15th of 50 states for that specialty) and weakest for diagnostic radiology (23rd of 51).
Against Medicare, gastroenterology has the highest ratio in Vermont (188% of Medicare) and dermatology the lowest (111%).
Payer ranking in Vermont
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 142 | 1 | 222 | 279 | 117 | |
| Cigna | 109 | 2 | 220 | 302 | 133 | |
| Blue Cross Blue Shield | 89 | 3 | 224 | 312 | 205 | |
| Aetna | 74 | 4 | 56 | 279 | 162 |
Reimbursement index by specialty in Vermont
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Ophthalmology | 117 | 15 of 50 | 140% | 42 | 38 | |
| Dermatology | 112 | 16 of 50 | 111% | 44 | 22 | |
| Internal medicine | 108 | 18 of 51 | 126% | 25 | 117 | |
| Cardiology | 106 | 19 of 51 | 153% | 38 | 28 | |
| Gastroenterology | 105 | 19 of 50 | 188% | 36 | 26 | |
| Urology | 106 | 19 of 50 | 167% | 37 | 31 | |
| Orthopedic surgery | 106 | 22 of 51 | 155% | 39 | 38 | |
| Diagnostic radiology | 101 | 23 of 51 | 153% | 49 | 65 |
Specialty by payer in Vermont
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 211 | 77 | 105 | 98 |
| Dermatology | 144 | n/a | 110 | 104 |
| Ophthalmology | 129 | n/a | 108 | 103 |
| Cardiology | 155 | n/a | 144 | 91 |
| Orthopedic surgery | 164 | n/a | 108 | 91 |
| Diagnostic radiology | 162 | 76 | 128 | 86 |
| Urology | 176 | n/a | 132 | 91 |
| Gastroenterology | 130 | n/a | 122 | 103 |
Vermont compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Vermont | 107 | 18 | 157% | 365 | |
| New Jersey | 100 | 22 | 154% | 887 | |
| Maine | 100 | 23 | 148% | 647 | |
| Rhode Island | 99 | 26 | 148% | 632 | |
| Pennsylvania | 96 | 30 | 143% | 892 | |
| New Hampshire | 121 | 14 | 174% | 734 |
Procedures that pay most and least in Vermont vs the nation
Highest vs national
| Code | Vermont | National | Gap | Prov. |
|---|---|---|---|---|
| 64566 Neuroeltrd stim post tibial | $103 | $69 | +49% | 30 |
| 45380 Colonoscopy and biopsy | $650 | $470 | +38% | 23 |
| 11102 Tangntl bx skin single les | $90 | $65 | +38% | 21 |
| 26055 Incise finger tendon sheath | $837 | $614 | +36% | 35 |
| 43235 Egd diagnostic brush wash | $400 | $294 | +36% | 23 |
| 45378 Diagnostic colonoscopy | $550 | $408 | +35% | 23 |
| 11104 Punch bx skin single lesion | $108 | $81 | +34% | 21 |
| 45385 Colonoscopy w/lesion removal | $733 | $549 | +34% | 129 |
| 93010 Electrocardiogram report | $17 | $13 | +34% | 25 |
| 45384 Colonoscopy w/lesion removal | $675 | $519 | +30% | 23 |
| 11301 Shave skin lesion 0.6-1.0 cm | $110 | $85 | +30% | 21 |
| 51702 Insert temp bladder cath | $78 | $61 | +28% | 30 |
| 88305 Tissue exam by pathologist | $90 | $70 | +28% | 44 |
| 11302 Shave skin lesion 1.1-2.0 cm | $124 | $98 | +27% | 21 |
| 68761 Close tear duct opening | $207 | $164 | +26% | 35 |
Lowest vs national
| Code | Vermont | National | Gap | Prov. |
|---|---|---|---|---|
| 52000 Cystourethroscopy | $182 | $210 | -13% | 30 |
| 70553 Mri brain stem w/o & w/dye | $520 | $600 | -13% | 63 |
| 72158 Mri lumbar spine w/o & w/dye | $522 | $593 | -12% | 63 |
| 90960 Esrd srv 4 visits p mo 20+ | $402 | $453 | -11% | 108 |
| 70450 Ct head/brain w/o dye | $175 | $194 | -10% | 63 |
| 77080 Dxa bone density axial | $60 | $66 | -10% | 63 |
| 70498 Ct angiography neck | $422 | $459 | -8% | 63 |
| 70496 Ct angiography head | $422 | $457 | -8% | 63 |
| 20611 Drain/inj joint/bursa w/us | $108 | $117 | -7% | 35 |
| 93229 Remote 30 day ecg tech supp | $1,008 | $1,088 | -7% | 24 |
| 92928 Prq tcat plmt ntrac st 1 les | $824 | $887 | -7% | 25 |
| 72197 Mri pelvis w/o & w/dye | $594 | $634 | -6% | 63 |
| 74183 Mri abd w/o cntr flwd cntr | $595 | $634 | -6% | 63 |
| 93970 Extremity study | $258 | $272 | -5% | 88 |
| 71260 Ct thorax dx c+ | $298 | $312 | -4% | 63 |
Frequently asked questions
How do commercial reimbursement rates in Vermont compare with the rest of the country?
Vermont ranks 18th of 51 states with an index of 107, across 228 procedure codes. Median commercial rates run 157% of the Medicare rate.
Which payer has the highest rates in Vermont?
In the files we analyzed, UnitedHealthcare has the highest index (142) and Aetna the lowest (74). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Vermont?
Ophthalmology ranks 15th of 50 states.
How many providers does this Vermont page cover?
365 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Vermont and the national median?
CPT 64566 (Neuroeltrd stim post tibial) is highest relative to the nation at 149% of the national median; CPT 52000 (Cystourethroscopy) is lowest at 87%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Vermont contracts
Compare your negotiated rates with these state medians by payer and specialty.