CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Highland Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $153
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Highland Hospital is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.30x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$153

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Insurance Median: $153 (130%)

Ins. Median: $153 (130% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
Medicaid / KanCare	$25 - $271	21%
Amerigroup (Bswny Alternate) [1720]	$32 - $271	27%
Excellus [2201]	$32 - $296	27%
UnitedHealthcare	$32 - $271	27%
Aetna	$65 - $288	55%
Excellus Bc/Bs [2201]	$65 - $195	55%
Medicare (plans)	$65 - $221	55%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$75 - $362	64%
Elderplan [1316]	$77 - $105	65%
Humana	$77 - $195	65%
Icircle [1728]	$77 - $105	65%
Martins Point [1205]	$77 - $152	65%
Nascentia [1729]	$77 - $105	65%
Molina Healthcare [5189], Molina Healthcare [1723]	$83 - $271	71%
Fidelis [5155]	$93 - $271	79%
Highmark Bc/Bs Of Western Ny [5143]	$114 - $139	97%
Independent Health [5156]	$114 - $192	97%
Mvp [2900]	$120 - $514	102%
Cigna	$183 - $514	156%
Capital District Physicians Health Plan (Cdphp) [5149]	$203 - $367	173%

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Highland Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.