CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $73
Cash Discount Price: $300
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The University of Vermont Health Network-Alice Hy is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $300. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.77x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$300

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $300 (315%)

Insurance Median: $73 (77%)

Cash: $300 (315% of Medicare)

Ins. Median: $73 (77% 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
Fidelis Care	$53 - $73	56%
Humana	$53 - $73	56%
Mvp	$53 - $81	56%
Aetna	$62 - $195	65%
Veterans Affairs Community Care Network	$62 - $73	65%
Capital District Physicians' Health Plan	$63 - $213	66%
Blue Cross Blue Shield	$64 - $187	67%
UnitedHealthcare	$64 - $203	67%
St. Regis	$70 - $73	74%
Choicecare	$73 - $170	77%
Martins Point	$73 - $86	77%
Highmark Blueshield	$203 - $366	213%
Magnacare	$298	313%

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 $300.
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-Alice Hy 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.