CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: South Miami Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $254
Cash Discount Price: $346
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at South Miami Hospital is $254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $346. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.87x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$346

Average discount available for prompt cash payment at this facility.

Insurance Median

$254

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: $346 (255%)

Insurance Median: $254 (187%)

Cash: $346 (255% of Medicare)

Ins. Median: $254 (187% 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
Avmed	$16 - $579	12%
UnitedHealthcare	$20 - $1,169	15%
Non Contracted	$23 - $429	17%
Aetna	$24 - $935	18%
Cigna	$24 - $935	18%
Blue Cross Blue Shield	$26 - $758	19%
Amerihealth	$28 - $526	21%
International	$41 - $760	30%
Dimension Health Plan	$47 - $1,052	35%
Affordable	$54 - $994	40%
Phcs	$57 - $1,052	42%
Quality Health	$57 - $1,052	42%

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 $346.
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 South Miami 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.