CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Larkin Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $140
  • Cash Discount Price: $177
  • vs. Medicare Baseline: 1.47x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Larkin Community Hospital is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.47x the Medicare baseline. Located in 7031 Sw 62Nd Ave, South Miami, FL.
Cash / Self-Pay
$177

Average discount available for prompt cash payment at this facility.

Insurance Median
$140

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: $177 (186%)
Insurance Median: $140 (147%)
Cash: $177 (186% of Medicare)
Ins. Median: $140 (147% 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.

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
Cigna $18 - $110 19%
Healthsun-All Plans $21 - $1,700 22%
Humana $21 - $750 22%
Medicaid / KanCare $21 - $654 22%
Star Network-All Plans $28 - $177 29%
Jmh Health Plan Hmo/Ppo-All Other Plans $38 - $750 40%
Global Excel-All Plans $42 - $265 44%
Haa Preferred Partners-All Plans $42 - $265 44%
Medicare (plans) $49 - $464 51%
Molina Exch Marketplace-All Other Plans $62 65%
Corvel Mcare Workers Comp-All Plans $63 - $398 66%
Blue Cross Blue Shield $66 - $9,184 69%
Jipa Network-All Plans $67 - $425 70%
Aetna $69 - $654 72%
Fci-All Plans $69 - $79 72%
Florida Comm Care Mcare-All Other Plans $69 72%
Ops Maritime-All Plans $69 72%
Opus Hospice Ip Only-All Plans $69 72%
Preferred Care Partners Mcare-All Plans $69 72%
UnitedHealthcare $69 - $711 72%
Avmed-All Plans $70 - $654 74%
Careplus Health-All Other Plans $70 - $442 74%
Carisk Concordia Behavioral-All Plans $70 74%
Centurion-All Plans $70 - $442 74%
Coventry Comml-All Plans $70 - $654 74%
Doctors Healthcare-All Plans $70 - $442 74%
First Med Hp Of Fl-All Plans $70 - $442 74%
Florida Health Solution/Hmo-All Plans $70 - $1,400 74%
Clear Springs Hlth-All Plans $73 77%
Unicare Simply Mcare Ppo-All Plans $73 77%
Wellpath-All Plans $76 80%
Fdc-All Plans $79 83%
Bright Health-All Other Plans $84 - $654 88%
Allianz (Azga)-All Plans $90 95%
Oscar Health-All Plans $140 - $884 147%
United Prop Casualty-All Plans $155 - $462 163%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 7031 Sw 62Nd Ave, South Miami, FL 33143
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals