CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Northwest Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $127
Cash Discount Price: $564
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Northwest Hospital is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $564. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.33x the Medicare baseline. Located in 2801 N State Rd 7, Margate, FL.

Cash / Self-Pay

$564

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $564 (592%)

Insurance Median: $127 (133%)

Cash: $564 (592% of Medicare)

Ins. Median: $127 (133% 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	$28 - $315	29%
Blue Cross Blue Shield	$30 - $238	32%
Freedom Health	$35 - $168	37%
Optimum	$35	37%
Simply Healthcare Plans	$53	56%
Corvel Corporation	$57 - $148	60%
Careworks (Rockport)	$58 - $151	61%
Prime Health	$58 - $151	61%
Simply Healthcare	$76 - $142	80%
Molina	$77 - $284	81%
Cigna	$85	89%
Humana	$85 - $138	89%
Health Sun Health Plan	$87 - $224	91%
Oscar	$90 - $168	95%
Mmm Of Fl (Health Advantage Plan)	$94	99%
Amerihealth Caritas	$96 - $179	101%
United Ppo	$96 - $249	101%
Sunshine State Health Plan	$107 - $277	112%
Blis	$142 - $368	149%
United	$183 - $473	192%
Plotkin Health	$204 - $526	214%
Prime Health Sherriff	$204 - $526	214%
Medica Healthcare	$236	248%
Avmed	$282 - $526	296%
Multiplan	$305 - $893	320%

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 $564.
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 Northwest 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.