CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida North Florida Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $214
Cash Discount Price: $663
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida North Florida Hospital is $214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $663. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.25x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

$663

Average discount available for prompt cash payment at this facility.

Insurance Median

$214

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: $663 (697%)

Insurance Median: $214 (225%)

Cash: $663 (697% of Medicare)

Ins. Median: $214 (225% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). 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
Blue Cross Blue Shield	$24 - $425	25%
Aetna	$25 - $505	26%
Corvel Corporation	$55 - $142	58%
United	$55 - $758	58%
Prime Health	$56 - $145	59%
Simply	$57 - $259	60%
Careworks (Rockport Community)	$58 - $149	61%
Cigna	$64 - $701	67%
Molina Healthcare	$70 - $539	74%
Humana	$74 - $337	78%
Sunshine State Health Plan	$94 - $430	99%
Avmed	$185 - $842	194%
Plotkin Health	$185 - $842	194%
Prime Health Sheriff	$185 - $842	194%
Corizon Phs	$222 - $1,011	233%
Multiplan	$288 - $1,432	303%
Evernorth	$295 - $1,348	310%
Evolutions Healthcare	$314 - $1,432	330%
Ppo Next	$314 - $1,432	330%
Novanet	$332 - $1,516	349%
Beacon Health Options	$369 - $1,685	388%
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 $663.
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 North Florida 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.