CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Baptist Hospital of Miami

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $127
Cash Discount Price: $257
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Baptist Hospital of Miami is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $257. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.33x the Medicare baseline. Located in 8900 N Kendall Dr, Miami, FL.

Cash / Self-Pay

$257

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $257 (270%)

Insurance Median: $127 (133%)

Cash: $257 (270% of Medicare)

Ins. Median: $127 (133% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
Blue Cross Blue Shield	$10 - $476	11%
Aetna	$12 - $588	13%
Avmed	$14 - $362	15%
UnitedHealthcare	$18 - $735	19%
Non Contracted	$21 - $270	22%
Cigna	$22 - $588	23%
Amerihealth	$26 - $331	27%
International	$37 - $478	39%
Dimension Health Plan	$43 - $662	45%
Affordable	$48 - $625	50%
Phcs	$51 - $662	54%
Quality Health	$51 - $662	54%
Sunshine State	$74	78%
Vista	$173	182%

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 $257.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Baptist Hospital of Miami is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.