CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Anthony Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $389
Cash Discount Price: $616
vs. Medicare Baseline: 2.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Anthony Community Hospital is $389. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $616. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.87x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

$616

Average discount available for prompt cash payment at this facility.

Insurance Median

$389

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: $616 (454%)

Insurance Median: $389 (287%)

Cash: $616 (454% of Medicare)

Ins. Median: $389 (287% 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 287% of the Medicare baseline (a markup of 187%). 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
Self-Pay - Cc 50%	$25 - $308	18%
Mvp Gold (McR)	$111	82%
Mvp Exchange	$122 - $406	90%
Mvp Hmo/Ppo	$143 - $790	105%
Self-Pay - Cc 30%	$185	136%
Blue Cross Blue Shield	$234 - $474	173%
Aetna	$277 - $308	204%
Cdphp	$308	227%
Oxford Exchange	$406 - $431	299%
UnitedHealthcare	$406 - $478	299%
Emblem Select Care (Exchange)	$419	309%
Oxford Commercial	$431 - $546	318%
Cigna	$431	318%
Multiplan	$462	341%
PHCS	$462	341%
Emblem Ghi/Hip Hmo/Epo/Pos	$493	364%
Emblem Ghi/Hip PPO	$493	364%
Magnacare Preferred	$554	409%
First Health	$616	454%
Tricare	$616 - $50,000	454%

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 $616.
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 St Anthony Community 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.