CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Sisters of Charity Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $113
Cash Discount Price: $235
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Sisters of Charity Hospital is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $235. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.83x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$235

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

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: $235 (173%)

Insurance Median: $113 (83%)

Cash: $235 (173% of Medicare)

Ins. Median: $113 (83% 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
Blue Cross Blue Shield	$56 - $156	41%
Medicaid / KanCare	$84 - $124	62%
Beacon Essential [350122]	$84 - $112	62%
UnitedHealthcare	$93 - $124	69%
Medicare (plans)	$94 - $130	69%
Federal Workers Compensation [500100]	$94 - $102	69%
Hospice [550001]	$94 - $124	69%
Univera Healthcare Essential [100170]	$101	74%
Univera Healthcare [100169]	$101 - $138	74%
No Fault [114001]	$102	75%
Workers Compensation [500101]	$102	75%
UPMC Health Plan [100181]	$105	77%
Fidelis Essential [100163]	$111 - $149	82%
Vna Option Mltc [350110]	$112	83%
Amerigroup [350102]	$112	83%
Tuscarora Nation [550120]	$112	83%
Crime Victims [100176]	$112	83%
Excellus Rochester McD [350117]	$112	83%
Beacon Health Options [100023]	$112	83%
Independent Health Essential [100166]	$112	83%
Mvp Healthcare [100168]	$118	87%
Covid19 Hrsa [45013]	$124	91%
Catholic Health Life Pace [400005]	$124	91%
Meritain [100063]	$124	91%
VA Veterans Affairs [700001]	$124	91%
Cigna	$124 - $180	91%
Magnacare [100142]	$124	91%
Aetna	$124	91%
Seneca Nation [450119]	$124	91%
Humana	$124	91%
Tricare	$124	91%
Champ VA [700002]	$124	91%
Fallon Health [450115]	$124	91%
Wellcare Fidelis Dual [450451]	$130	96%
Fidelis Dual Advantage [450120]	$130	96%
Independent Health [100165]	$134	99%
Iha First Choice [800001]	$134	99%
Ghi [100153]	$136	100%
Wellcare [450129]	$136	100%
Fidelis Exchange [100164]	$149	110%
Molina Essential [100167]	$253	187%

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 $235.
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 Sisters of Charity Hospital 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.