CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Winter Haven Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $161
Cash Discount Price: $139
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Winter Haven Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.19x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $139 (103%)

Insurance Median: $161 (119%)

Cash: $139 (103% of Medicare)

Ins. Median: $161 (119% 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.

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	$42 - $137	31%
Simply Healthcare	$42 - $160	31%
Ultimate Health Plan	$69	51%
Avmed	$72 - $113	53%
Blue Cross Blue Shield	$74 - $133	55%
Humana	$92 - $159	68%
Florida Hospital	$106	78%
Aetna	$107 - $188	79%
Evolutions	$116 - $215	86%
Cigna	$122 - $201	90%
UnitedHealthcare	$123 - $208	91%
Clear Health Alliance	$154	114%
Freedom Health	$160	118%
Molina Healthcare	$160	118%
Sunshine Health	$160	118%
Florida Community Care	$168	124%
Multiplan	$185	136%
First Health	$196	145%
Ambetter / Centene	$231	170%
United Behavioral Health	$231	170%

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 $139.
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 Winter Haven 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.