CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The University of Vermont Health Network - Champl

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $91
Cash Discount Price: $419
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The University of Vermont Health Network - Champl is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $419. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.96x the Medicare baseline. Located in 75 Beekman Street, Plattsburgh, NY.

Cash / Self-Pay

$419

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $419 (440%)

Insurance Median: $91 (96%)

Cash: $419 (440% of Medicare)

Ins. Median: $91 (96% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Beacon Health	$39 - $69	41%
Mvp	$53 - $343	56%
Aetna	$62 - $307	65%
Blue Cross Blue Shield	$62 - $276	65%
Fidelis Care	$62 - $65	65%
Humana	$62	65%
Veterans Affairs Community Care Network	$62 - $65	65%
UnitedHealthcare	$64 - $329	67%
St. Regis	$70	74%
Capital District Physicians' Health Plan	$86 - $340	90%
Martins Point	$86	90%
Wellpath	$87	91%
Highmark Blueshield	$90 - $319	95%
Harvard Pilgrim	$326 - $345	342%
Magnacare	$326	342%
Emblem Health	$345	362%
Coventry	$366 - $388	384%
Multiplan	$387 - $409	407%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $419.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The University of Vermont Health Network - Champl is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.