CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Flushing Hospital Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $108
Cash Discount Price: $524
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Flushing Hospital Medical Center is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $524. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 45Th Avenue and Parsons Boulevard, Flushing, NY.

Cash / Self-Pay

$524

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $524 (386%)

Insurance Median: $108 (80%)

Cash: $524 (386% of Medicare)

Ins. Median: $108 (80% 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
Ghi	$35 - $94	26%
UnitedHealthcare	$68 - $230	50%
Healthfirst	$80	59%
Fidelis	$89 - $94	66%
Aetna	$94 - $278	69%
Beacon Health Strategies	$94	69%
Centerlight Healthcare	$94	69%
Empire	$94 - $207	69%
Hip	$94 - $610	69%
Humana	$94 - $99	69%
Metroplus	$94 - $103	69%
Elderplan	$95	70%
Vns	$95	70%
Wellcare Of Ny	$97	72%
Senior Whole Health	$99	73%
Elderserve Health	$108	80%
Magnacare	$108 - $1,485	80%
Hamaspik Choice	$112	83%
Valueoptions	$133	98%
Hotel Trades Council – Detox/Mental	$135	100%
Emblemhealth	$146	108%
United Behavioral Health	$157 - $168	116%
Empire Blue Priority	$176	130%
Centers Plan For Healthy Living	$200	147%
Cigna	$289	213%
Villagecaremax	$313	231%
Oscar	$438	323%
Centivo	$456	336%
Create Health Plan	$1,414	1043%
Hotel Trades Council	$1,912	1410%

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 $524.
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 Flushing Hospital Medical Center 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.