CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Orange Park Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $270
Cash Discount Price: $1,038
vs. Medicare Baseline: 2.84x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Orange Park Hospital is $270. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,038. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.84x the Medicare baseline. Located in 2001 Kingsley Ave, Orange Park, FL.

Cash / Self-Pay

$1,038

Average discount available for prompt cash payment at this facility.

Insurance Median

$270

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: $1,038 (1090%)

Insurance Median: $270 (284%)

Cash: $1,038 (1090% of Medicare)

Ins. Median: $270 (284% 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 284% of the Medicare baseline (a markup of 184%). 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	$53 - $279	56%
Corvel Corporation	$55 - $134	58%
Prime Health	$56 - $137	59%
Optimum Healthcare	$84 - $90	88%
United	$119 - $520	125%
Simply Healthcare	$147 - $165	154%
Aetna	$171 - $347	180%
Oscar	$185	194%
Positive Healthcare	$219 - $236	230%
Cigna	$238 - $304	250%
Sunshine State Health Plan	$254 - $295	267%
Molina Healthcare	$269 - $312	283%
Humana	$408 - $440	429%
Medicare (plans)	$448 - $483	471%
Plotkin Health	$497 - $578	522%
Multiplan	$776 - $983	815%
Evernorth	$796 - $925	836%
Evolutions Healthcare	$796 - $983	836%
Ppo Next	$846 - $983	889%
Novanet	$895 - $1,040	940%
United Behavioral Health	$995 - $1,156	1045%
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 $1,038.
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 Orange Park 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.