CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Highland Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $116
Cash Discount Price: $218
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Highland Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $218. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.22x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$218

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $218 (229%)

Insurance Median: $116 (122%)

Cash: $218 (229% of Medicare)

Ins. Median: $116 (122% 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
Amerigroup (Bswny Alternate) [1720]	$17 - $190	18%
Excellus [2201]	$17 - $215	18%
Medicaid / KanCare	$17 - $256	18%
UnitedHealthcare	$17 - $190	18%
Medicare (plans)	$24 - $221	25%
Molina Healthcare [5189], Molina Healthcare [1723]	$44 - $190	46%
Aetna	$53 - $233	56%
Excellus Bc/Bs [2201]	$53 - $159	56%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$60 - $296	63%
Elderplan [1316]	$62 - $86	65%
Icircle [1728]	$62 - $86	65%
Martins Point [1205]	$62 - $152	65%
Nascentia [1729]	$62 - $86	65%
Humana	$63 - $195	66%
Mvp [2900]	$63 - $430	66%
Highmark Bc/Bs Of Western Ny [5143]	$69 - $82	72%
Fidelis [5155]	$75 - $190	79%
Independent Health [5156]	$76 - $130	80%
Cigna	$148 - $476	155%
Capital District Physicians Health Plan (Cdphp) [5149]	$162 - $296	170%

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 $218.
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 Highland 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.