CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Raulerson Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $301
Cash Discount Price: $1,499
vs. Medicare Baseline: 3.16x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Raulerson Hospital is $301. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,499. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.16x the Medicare baseline. Located in 1796 Hwy 441 North, Okeechobee, FL.

Cash / Self-Pay

$1,499

Average discount available for prompt cash payment at this facility.

Insurance Median

$301

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: $1,499 (1575%)

Insurance Median: $301 (316%)

Cash: $1,499 (1575% of Medicare)

Ins. Median: $301 (316% 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 316% of the Medicare baseline (a markup of 216%). 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
Corvel Corporation	$55 - $126	58%
Careworks (Rockport)	$56 - $129	59%
Prime Health	$56 - $129	59%
Blue Cross Blue Shield	$94 - $361	99%
Aetna	$103 - $450	108%
Optimum	$129	136%
Oscar	$285	299%
Health Sun Health Plan	$319	335%
Simply Healthcare	$352	370%
Sunshine State Health Plan	$382	401%
Molina	$405	425%
United Ppo	$660	693%
United	$675	709%
Avmed	$750	788%
Plotkin Health	$750	788%
Prime Health Sherriff	$750	788%
Multiplan	$1,124 - $1,274	1181%

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 $1,499.
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 Raulerson 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.