CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Cayuga Medical Center at Ithaca

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $321
Cash Discount Price: $105
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cayuga Medical Center at Ithaca is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.37x the Medicare baseline. Located in 101 Dates Drive, Ithaca, NY.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $105 (77%)

Insurance Median: $321 (237%)

Cash: $105 (77% of Medicare)

Ins. Median: $321 (237% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 237% of the Medicare baseline (a markup of 137%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Molina	$94 - $221	69%
Aetna	$155 - $566	114%
Excellus	$244 - $575	180%
Cigna	$260 - $613	192%
UnitedHealthcare	$285 - $671	210%
Emblem Health	$291 - $686	215%
Independent Health	$300 - $708	221%
Wellcare	$319 - $752	235%
Martins Point	$322 - $759	237%
Fidelis	$704 - $1,659	519%

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 $105.
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 Cayuga Medical Center at Ithaca 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.