CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida South Shore Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $121
Cash Discount Price: $912
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida South Shore Hospital is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $912. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.27x the Medicare baseline. Located in 4016 Sun City Center Blvd, Sun City Center, FL.

Cash / Self-Pay

$912

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $912 (958%)

Insurance Median: $121 (127%)

Cash: $912 (958% of Medicare)

Ins. Median: $121 (127% 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
Access 2 Healthcare Physicians Freedom Optimum Group Members	$22 - $64	23%
Blue Cross Blue Shield	$24 - $285	25%
Aetna	$32 - $409	34%
Access 2 Healthcare Physicians Freedom Health	$33 - $98	35%
Access 2 Healthcare Physicians Optimum	$33 - $98	35%
Freedom Health Care	$36 - $106	38%
Optimum Healthcare	$36 - $106	38%
Truli	$38 - $166	40%
Corvel Corporation	$55 - $136	58%
Rockport Healthcare Group	$55 - $136	58%
Prime Health	$56 - $139	59%
Simply Healthcare	$71 - $210	75%
United	$76 - $614	80%
Cigna	$83 - $245	87%
Molina	$88 - $368	92%
Sunshine State Health Plan	$118 - $348	124%
Humana	$129 - $382	136%
Plotkin Health	$231 - $682	243%
Prime Health Sheriff	$231 - $682	243%
Evolutions Healthcare Systems	$254 - $1,255	267%
Multiplan	$346 - $1,159	363%

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 $912.
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 South Shore 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.