CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Suny/Stony Brook University Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $97
  • Cash Discount Price: $608
  • vs. Medicare Baseline: 0.72x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Suny/Stony Brook University Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $608. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.72x the Medicare baseline. Located in Health Sciences Center SUNY, Stony Brook, NY.
Cash / Self-Pay
$608

Average discount available for prompt cash payment at this facility.

Insurance Median
$97

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: $608 (448%)
Insurance Median: $97 (72%)
Cash: $608 (448% of Medicare)
Ins. Median: $97 (72% 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.

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
Aetna $96 - $97 71%
Blue Cross Blue Shield $96 71%
Elderplan $96 71%
Fidelis Care $96 71%
Healthfirst Health Plan $96 71%
UnitedHealthcare $96 - $4,255 71%
Emblemhealth Hip Of Ny $97 72%
Agewell New York $105 77%
Centerlight $124 91%
Partners Health Plan $124 91%
Beacon Health Options $159 117%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Health Sciences Center SUNY, Stony Brook, NY 11794
  • CMS Rating: ★★★★★
  • Ownership Type: Government - State
  • Hospital Type: Acute Care Hospitals