CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Hialeah Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $224
Cash Discount Price: $1,306
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Hialeah Hospital is $224. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,306. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.65x the Medicare baseline. Located in 651 E 25Th St, Hialeah, FL.

Cash / Self-Pay

$1,306

Average discount available for prompt cash payment at this facility.

Insurance Median

$224

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: $1,306 (963%)

Insurance Median: $224 (165%)

Cash: $1,306 (963% of Medicare)

Ins. Median: $224 (165% 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
Aetna	$39 - $940	29%
Oscar Health Plan Hix	$80	59%
Humana	$117 - $598	86%
Medicaid / KanCare	$117 - $123	86%
UnitedHealthcare	$119 - $444	88%
Imagine Health	$131	97%
Healthsun Health Plans	$138	102%
Self Pay/Uninsured	$165	122%
Employer Direct Healthcare	$168 - $177	124%
Bc/Bs Myblue Hmo Hix	$199	147%
Bc/Bs Of Fl Health Options Hmo	$199	147%
Bc/Bs Of Fl Miami Dade Blue Select	$199	147%
Bc/Bs Of Fl Network Blue	$199	147%
Bc/Bs Of Fl Simplyblue	$199	147%
Dimension Health Wc	$206	152%
Workers Compensation	$206	152%
Bc/Bs Of Fl Blue Select Exchange Non Par	$212	156%
Bc/Bs Of Fl Ppo	$224	165%
Bc/Bs Of Fl Phs	$677	499%
Dimensions International	$849	626%
Naphcare Inc	$849	626%
First Health	$888	655%
Tricare	$914	674%
Dimension Health Ppo	$979	722%
Commercial Non-Contracted	$1,306	963%
Self Pay - Mcd Pending 100 Percent	$1,306	963%
Single Case Agreement	$1,306	963%

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 $1,306.
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 Hialeah 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.