CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Brattleboro Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $186
Cash Discount Price: $168
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Brattleboro Memorial Hospital is $186. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.95x the Medicare baseline. Located in 17 Belmont Ave, Brattleboro, VT.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$186

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: $168 (176%)

Insurance Median: $186 (195%)

Cash: $168 (176% of Medicare)

Ins. Median: $186 (195% 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
Amerihealth-Caritas	$55	58%
New Hampshire Healthy Families	$55	58%
Wellsense	$55 - $132	58%
Blue Cross Blue Shield	$62 - $417	65%
Cigna	$62 - $440	65%
Harvard Pilgrim Health Care	$62 - $403	65%
Martin'S Point	$62 - $124	65%
Mvp Healthcare	$62 - $417	65%
New Hampshire Healthy Families (Wellcare)	$65 - $130	68%
Tufts Health Plan	$68 - $424	71%
Vermont Health Plan	$96 - $415	101%
Humana	$124	130%
UnitedHealthcare	$124 - $440	130%
Aetna	$148 - $449	155%
Coventry	$148 - $449	155%
Health New England	$148 - $449	155%
Multiplan	$148 - $449	155%

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 $168.
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 Brattleboro Memorial Hospital 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.