CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Hialeah Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $156
Cash Discount Price: $504
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Hialeah Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $504. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.64x the Medicare baseline. Located in 651 E 25Th St, Hialeah, FL.

Cash / Self-Pay

$504

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $504 (529%)

Insurance Median: $156 (164%)

Cash: $504 (529% of Medicare)

Ins. Median: $156 (164% 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
Aetna	$15 - $363	16%
Oscar Health Plan Hix	$31	33%
Imagine Health	$50	53%
Bc/Bs Myblue Hmo Hix	$77	81%
Bc/Bs Of Fl Health Options Hmo	$77	81%
Bc/Bs Of Fl Miami Dade Blue Select	$77	81%
Bc/Bs Of Fl Network Blue	$77	81%
Bc/Bs Of Fl Simplyblue	$77	81%
Bc/Bs Of Fl Blue Select Exchange Non Par	$82	86%
Bc/Bs Of Fl Ppo	$86	90%
Healthsun Health Plans	$98	103%
UnitedHealthcare	$114 - $171	120%
Humana	$117 - $231	123%
Medicaid / KanCare	$117 - $123	123%
Self Pay/Uninsured	$117	123%
Employer Direct Healthcare	$119 - $177	125%
Dimension Health Wc	$156	164%
Workers Compensation	$156	164%
Bc/Bs Of Fl Phs	$261	274%
Dimensions International	$327	344%
Naphcare Inc	$327	344%
First Health	$342	359%
Tricare	$353	371%
Dimension Health Ppo	$378	397%
Commercial Non-Contracted	$504	529%
Self Pay - Mcd Pending 100 Percent	$504	529%
Single Case Agreement	$504	529%

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 $504.
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 Hialeah Hospital 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.