CMS Price Transparency Data

Diagnostic procedure preparation

Facility: Porter Hospital Inc

Billing Code: G0279 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0279
Insurance Median: $29
Cash Discount Price: $64
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Diagnostic procedure preparation at Porter Hospital Inc is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.72x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $64 (158%)

Insurance Median: $29 (72%)

Cash: $64 (158% of Medicare)

Ins. Median: $29 (72% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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
Harvard Pilgrim	$16	40%
UnitedHealthcare	$19 - $62	47%
Mvp	$23 - $56	57%
Fidelis Care	$24	59%
Humana	$26	64%
Veterans Choice	$27	67%
Martins Point	$27	67%
Veterans Affairs Community Care Network	$27	67%
Capital District Physicians' Health Plan	$27 - $44	67%
Aetna	$27	67%
Blue Cross Blue Shield	$31 - $49	77%
Cigna	$32	79%
Coventry	$35	87%
Wellpath	$35	87%
Medical Corporation	$61	151%
Multiplan	$61	151%

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 $64.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0279.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Porter Hospital Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0279.
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.