CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Central Florida Lake Monroe Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $321
Cash Discount Price: $1,663
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Central Florida Lake Monroe Hospital is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,663. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.37x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$1,663

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $1,663 (1226%)

Insurance Median: $321 (237%)

Cash: $1,663 (1226% of Medicare)

Ins. Median: $321 (237% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 237% of the Medicare baseline (a markup of 137%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$59 - $743	44%
Blue Cross Blue Shield	$60 - $525	44%
Freedom Health	$61 - $178	45%
Optimum	$61 - $178	45%
Truli For Health	$72 - $210	53%
Corvel Corporation	$85 - $178	63%
Prime Health	$86 - $182	63%
Careworks (Rockport Community)	$89 - $187	66%
Simply	$131 - $381	97%
Cigna	$148 - $431	109%
Molina Healthcare	$162 - $792	119%
Humana	$170 - $495	125%
Sunshine State Health Plan	$217 - $631	160%
United	$284 - $1,114	209%
Florida Health Care Plan	$321 - $933	237%
Avmed	$425 - $1,238	313%
Plotkin Health	$425 - $1,238	313%
Prime Health Sheriff	$425 - $1,238	313%
Multiplan	$638 - $2,105	471%
Three Rivers Provider Network	$638 - $1,857	471%
Ppo Next	$723 - $2,105	533%
Novanet	$765 - $2,228	564%
American Health Plan	$15,000	11062%

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 $1,663.
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 Central Florida Lake Monroe 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.