CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Univ. of Vermont - Fletcher Allen Health Care

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $189
Cash Discount Price: $285
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Univ. of Vermont - Fletcher Allen Health Care is $189. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $285. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.39x the Medicare baseline. Located in 111 Colchester Ave, Burlington, VT.

Cash / Self-Pay

$285

Average discount available for prompt cash payment at this facility.

Insurance Median

$189

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $285 (210%)

Insurance Median: $189 (139%)

Cash: $285 (210% of Medicare)

Ins. Median: $189 (139% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
UnitedHealthcare	$57 - $378	42%
Mvp	$75 - $265	55%
Blue Cross Blue Shield	$80 - $294	59%
Humana	$80 - $91	59%
Aetna	$91 - $131	67%
St. Regis	$91	67%
Veterans Affairs Community Care Network	$91 - $96	67%
Fidelis Care	$105	77%
Capital District Physicians' Health Plan	$122 - $242	90%
Martins Point	$122	90%
Wellpath	$128 - $210	94%
Cigna	$152 - $256	112%
Harvard Pilgrim	$228 - $306	168%
Magnacare	$228 - $306	168%
Coventry	$242 - $325	178%
Ebpa	$245 - $294	181%
Nppn	$256 - $344	189%

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 $285.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Univ. of Vermont - Fletcher Allen Health Care is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.