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CMS Price Transparency Data Hospital file updated: 2026-03-31

Office visit, established patient (20-29 min)

Facility: Samaritan Hospital of Troy, New York

Billing Code: 99213 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
$106Fair BaseRate (1.35× Market)
Position vs. 1.00× Fair Price+35% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $143 compared to the $106 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star Rating3/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score60/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

3-Star CMS clinical quality rating paired with 1.35× fair market pricing.

The BaseRate · fair price high confidence
A fair price for this
$106
about 1.1× the $95 Medicare rate · typically $63–$174
modeled estimate · not a bill or quote
What this hospital charges insurers
$143
Above the fair price
about $37 over the fair price · 1.5× Medicare
Medicare pays $95 Fair price $106 This hospital $143 Cash price $231 Hospital's list price $231

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $45 Priciest $143

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $106 (about 1.1× the $95 Medicare rate). Samaritan Hospital of Troy, New York charges insurers about $143, or about $231 in cash — above the fair price. Located in Troy, NY.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $106. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldAetnaCignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $46 - $231 48%
Blue Cross Blue Shieldmajor $53 - $295 56%
Aetnamajor $59 - $231 62%
Cignamajor $231 - $409 243%
Humanamajor $70 - $231 74%
Kaiser Permanentemajor $231 243%
Ambetter (Centene) $231 243%
AmeriHealth $231 243%
AvMed $231 243%
Bright Health $231 243%
CareSource $231 243%
Clover Health $231 243%
Dean Health Plan $231 243%
Fidelis Care $101 - $231 106%
Friday Health $231 243%
GEHA $143 - $231 150%
Geisinger $231 243%
Harvard Pilgrim $231 243%
Health Net $231 243%
HealthLink $231 243%
HealthPartners $231 - $409 243%
Independent Health $231 243%
MagnaCare $231 243%
Medica $231 243%
Medical Mutual $231 243%
Meridian $231 243%
Moda Health $231 243%
Molina $231 243%
MVP Health Care $103 - $231 108%
Oscar Health $231 243%
PacificSource $231 243%
Paramount $231 243%
Presbyterian $231 243%
Priority Health $231 - $409 243%
Providence Health Plan $231 243%
Sanford Health Plan $231 243%
Security Health Plan $231 243%
SelectHealth $231 243%
Sentara $231 243%
Tufts Health Plan $231 - $409 243%
UCare $231 243%
UniCare $175 - $231 184%
UPMC Health Plan $231 243%
WellCare $231 243%
WellMed $231 243%
WellSense $231 243%
+ 1048 smaller / regional plans $45 - $409
Government programs also on file: Medicare, Medicaid, Military & VA.
Excludes 42 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 2215 Burdett Avenue, Troy, NY 12180
  • CMS Rating: 3 / 5 Stars
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals

Other Procedures at Samaritan Hospital of Troy, New York

Compare: Office visit, established patient (20-29 min) at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Samaritan Hospital of Troy, New York (Zero PHI Required)

CMS CCN: 330180
CPT 99213
Fair BaseRate™ $106
Medicare Rate $95
Self-Pay Cash $231
Insurer Median $143
Pre-filled with Samaritan Hospital of Troy, New York’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $84 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $84

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $84).

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $231

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Samaritan Hospital of Troy, New York's published 45 CFR § 180 self-pay cash rate is $231 (vs. $143 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$125 Above Fair BaseRate

Negotiate Toward $106 Fair BaseRate ($95 Medicare)

Your bill ($231) is $125 above the denoised Fair BaseRate ($106) and 2.4× the $95 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 330180

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (141338544_samaritan-hospital_standardcharges.zip!141338544_Samaritan-Hospital_standardcharges.csv) Verify on CMS Medicare.gov (CCN 330180) ↗ CMS HCRIS Cost Reports ↗
Published MRF File141338544_samaritan-hospital_standardcharges.zip!141338544_Samaritan-Hospital_standardcharges.csv
Publication / Vintage2026-03-31 · 249.83 MB
Validated Rate Rows25,280,445 (CMS v3.0.0)
File Integrity Digest28e0d97d56067ffa7c60…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy