CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Hospital for Special Surgery

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $116
Cash Discount Price: $363
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Hospital for Special Surgery is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $363. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.86x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$363

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

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $363 (268%)

Insurance Median: $116 (86%)

Cash: $363 (268% of Medicare)

Ins. Median: $116 (86% 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
Metro Plus	$41 - $140	30%
Blue Cross Blue Shield	$65 - $215	48%
Fidelis	$70 - $138	52%
Aetna	$79 - $235	58%
Affinity By Molina Health Plan [1005]	$79 - $169	58%
Christian Brothers [1034]	$79 - $166	58%
Connecticare [1039]	$79 - $169	58%
Emblem Health [1043]	$79 - $169	58%
Fidelis Essential [1323]	$79	58%
Geha [1053]	$79	58%
Harvard Pilgrim [1057]	$79	58%
Medicare (plans)	$79	58%
Meritain Health [1085]	$79 - $166	58%
Nippon Life [1092]	$79 - $166	58%
Oxford [1096]	$79	58%
Student Resources [1103]	$79	58%
UnitedHealthcare	$79 - $264	58%
Webtpa [1356]	$79 - $166	58%
Emblem	$94 - $270	69%
Apwu [1016]	$136 - $151	100%
Cigna	$136 - $251	100%
Nalc [1090]	$136 - $151	100%
Qualcare [1101]	$136 - $151	100%
Wellfleet [1361]	$136 - $151	100%
Nyship	$200 - $267	147%
Horizon	$226	167%

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 $363.
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 Hospital for Special Surgery 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.