CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Jfk Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $90
Cash Discount Price: $386
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Jfk Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $386. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.95x the Medicare baseline. Located in 5301 S Congress Ave, Atlantis, FL.

Cash / Self-Pay

$386

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $386 (406%)

Insurance Median: $90 (95%)

Cash: $386 (406% of Medicare)

Ins. Median: $90 (95% 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	$24 - $217	25%
Blue Cross Blue Shield	$26 - $166	27%
Freedom Health	$30 - $116	32%
Optimum	$30 - $62	32%
Simply Healthcare Plans	$45 - $94	47%
Corvel Corporation	$57 - $141	60%
Careworks (Rockport)	$58 - $144	61%
Prime Health	$58 - $144	61%
Molina	$59 - $195	62%
Cigna	$73 - $152	77%
Humana	$73 - $246	77%
Health Sun Health Plan	$74 - $154	78%
Aids Healthcare	$77 - $868	81%
Mmm Of Fl (Health Advantage Plan)	$80 - $166	84%
United Ppo	$82 - $171	86%
Sunshine State Health Plan	$90 - $188	95%
Blis	$122 - $253	128%
United	$157 - $325	165%
District Cares	$174 - $362	183%
Plotkin Health	$174 - $362	183%
Prime Health Sherriff	$174 - $362	183%
Medica Healthcare	$205 - $427	215%
Multiplan	$261 - $615	274%
Evernorth Bh	$278 - $578	292%
Healthy Palm Beaches	$550	578%

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 $386.
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 HCA Florida Jfk 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.