CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Sarasota Doctors Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $187
Cash Discount Price: $1,082
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Sarasota Doctors Hospital is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,082. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.96x the Medicare baseline. Located in 5731 Bee Ridge Rd, Sarasota, FL.

Cash / Self-Pay

$1,082

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $1,082 (1137%)

Insurance Median: $187 (196%)

Cash: $1,082 (1137% of Medicare)

Ins. Median: $187 (196% 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
Access 2 Healthcare Physicians Freedom Optimum Group Members	$51	54%
Corvel Corporation	$55 - $136	58%
Rockport Healthcare Group	$55 - $136	58%
Prime Health	$56 - $139	59%
Aetna	$74 - $327	78%
Access 2 Healthcare Physicians Freedom Health	$77 - $78	81%
Access 2 Healthcare Physicians Optimum	$77 - $78	81%
Blue Cross Blue Shield	$79 - $221	83%
Freedom Health Care	$84 - $85	88%
Optimum Healthcare	$84 - $85	88%
Truli	$91 - $132	96%
Simply Healthcare	$166 - $168	174%
United	$176 - $490	185%
Cigna	$187 - $189	196%
Molina	$204 - $294	214%
Sunshine State Health Plan	$274 - $278	288%
Humana	$301 - $305	316%
Behealthy America	$419 - $425	440%
Beacon Health Options	$538 - $544	565%
Healthcare Sarasota	$538 - $544	565%
Plotkin Health	$538 - $544	565%
Prime Health Sheriff	$538 - $544	565%
Evolutions Healthcare Systems	$592 - $1,002	622%
Multiplan	$807 - $925	848%
Evernorth	$860 - $871	903%

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 $1,082.
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 Sarasota Doctors 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.