CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Hialeah Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $282
Cash Discount Price: $831
vs. Medicare Baseline: 2.40x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Hialeah Hospital is $282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $831. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.40x the Medicare baseline. Located in 651 E 25Th St, Hialeah, FL.

Cash / Self-Pay

$831

Average discount available for prompt cash payment at this facility.

Insurance Median

$282

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $831 (707%)

Insurance Median: $282 (240%)

Cash: $831 (707% of Medicare)

Ins. Median: $282 (240% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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 240% of the Medicare baseline (a markup of 140%). 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
Aetna	$25 - $598	21%
Oscar Health Plan Hix	$51	43%
Imagine Health	$83	71%
Humana	$117 - $380	100%
Medicaid / KanCare	$117 - $123	100%
UnitedHealthcare	$119 - $282	101%
Healthsun Health Plans	$122	104%
Bc/Bs Myblue Hmo Hix	$127	108%
Bc/Bs Of Fl Health Options Hmo	$127	108%
Bc/Bs Of Fl Miami Dade Blue Select	$127	108%
Bc/Bs Of Fl Network Blue	$127	108%
Bc/Bs Of Fl Simplyblue	$127	108%
Bc/Bs Of Fl Blue Select Exchange Non Par	$135	115%
Bc/Bs Of Fl Ppo	$142	121%
Self Pay/Uninsured	$145	123%
Employer Direct Healthcare	$148 - $236	126%
Dimension Health Wc	$293	249%
Workers Compensation	$293	249%
Bc/Bs Of Fl Phs	$431	367%
Dimensions International	$540	459%
Naphcare Inc	$540	459%
First Health	$565	481%
Tricare	$581	494%
Dimension Health Ppo	$623	530%
Commercial Non-Contracted	$831	707%
Self Pay - Mcd Pending 100 Percent	$831	707%
Single Case Agreement	$831	707%

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 $831.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hialeah Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.