CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Strong Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $167
Cash Discount Price: $326
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Strong Memorial Hospital is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $326. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.23x the Medicare baseline. Located in 601 Elmwood Ave, Rochester, NY.

Cash / Self-Pay

$326

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $326 (240%)

Insurance Median: $167 (123%)

Cash: $326 (240% of Medicare)

Ins. Median: $167 (123% 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
Medicaid / KanCare	$25 - $291	18%
Blue Cross Blue Shield	$29 - $434	21%
Excellus [2201]	$29 - $38	21%
UnitedHealthcare	$51 - $276	38%
Molina Healthcare [5189]	$64 - $84	47%
Aetna	$77 - $330	57%
Excellus Bc/Bs [2201]	$77 - $225	57%
Medicare (plans)	$77 - $252	57%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$89 - $418	66%
Elderplan [1316]	$91 - $121	67%
Icircle [1728]	$91 - $121	67%
Martins Point [1205]	$91 - $152	67%
Nascentia [1729]	$91 - $121	67%
Humana	$92 - $195	68%
Mvp [2900]	$92 - $592	68%
Highmark Bc/Bs Of Western Ny [5143]	$102 - $120	75%
Fidelis [5155]	$110 - $276	81%
Independent Health [5156]	$118 - $192	87%
Cigna	$218 - $592	161%
Capital District Physicians Health Plan (Cdphp) [5149]	$240 - $419	177%
Molina Healthcare [1723], Molina Healthcare [5189]	$274 - $276	202%

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 $326.
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 Strong Memorial Hospital 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.