CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Central Florida Lake Monroe Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $178
Cash Discount Price: $557
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Central Florida Lake Monroe Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $557. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.87x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$557

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

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: $557 (585%)

Insurance Median: $178 (187%)

Cash: $557 (585% of Medicare)

Ins. Median: $178 (187% 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	$38 - $557	40%
Blue Cross Blue Shield	$39 - $394	41%
Freedom Health	$40 - $134	42%
Optimum	$40 - $134	42%
Truli For Health	$47 - $158	49%
Corvel Corporation	$55 - $135	58%
Prime Health	$56 - $137	59%
Careworks (Rockport Community)	$58 - $142	61%
Simply	$86 - $286	90%
Cigna	$97 - $323	102%
Molina Healthcare	$106 - $594	111%
Humana	$111 - $371	117%
Sunshine State Health Plan	$142 - $473	149%
United	$186 - $835	195%
Florida Health Care Plan	$209 - $700	220%
Avmed	$278 - $928	292%
Plotkin Health	$278 - $928	292%
Prime Health Sheriff	$278 - $928	292%
Multiplan	$417 - $1,578	438%
Three Rivers Provider Network	$417 - $1,392	438%
Ppo Next	$472 - $1,578	496%
Novanet	$500 - $1,671	525%
American Health Plan	$15,000	15758%

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 $557.
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 Central Florida Lake Monroe 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.