CMS Price Transparency Data

Behavioral health assessment

Facility: Sisters of Charity Hospital

Billing Code: H0001 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: H0001
Insurance Median: $155
Cash Discount Price: $204
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Behavioral health assessment at Sisters of Charity Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $204. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$204

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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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	N/A
Independent Health Essential [100166]	$25 - $30	N/A
Medicare (plans)	$31 - $160	N/A
Independent Health [100165]	$44 - $59	N/A
Iha First Choice [800001]	$93	N/A
Mvp Healthcare [100168]	$110	N/A
Univera Healthcare [100169]	$127 - $186	N/A
Univera Healthcare Essential [100170]	$127	N/A
Excellus Rochester [100174]	$130	N/A
Hospice [550001]	$146	N/A
Blue Cross Blue Shield	$152 - $155	N/A
Workers Compensation [500101]	$230	N/A
No Fault [114001]	$230	N/A

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 $204.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: H0001.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sisters of Charity Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code H0001.
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.