CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: HCA Florida South Shore Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $150
Cash Discount Price: $1,177
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at HCA Florida South Shore Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,177. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.11x the Medicare baseline. Located in 4016 Sun City Center Blvd, Sun City Center, FL.

Cash / Self-Pay

$1,177

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $1,177 (868%)

Insurance Median: $150 (111%)

Cash: $1,177 (868% of Medicare)

Ins. Median: $150 (111% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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	$27 - $84	20%
Blue Cross Blue Shield	$29 - $373	21%
Aetna	$39 - $536	29%
Access 2 Healthcare Physicians Freedom Health	$41 - $129	30%
Access 2 Healthcare Physicians Optimum	$41 - $129	30%
Freedom Health Care	$44 - $139	32%
Optimum Healthcare	$44 - $139	32%
Truli	$47 - $218	35%
Corvel Corporation	$85 - $180	63%
Rockport Healthcare Group	$85 - $180	63%
Prime Health	$86 - $184	63%
Simply Healthcare	$87 - $275	64%
United	$93 - $804	69%
Cigna	$102 - $321	75%
Molina	$108 - $482	80%
Sunshine State Health Plan	$145 - $455	107%
Humana	$159 - $500	117%
Plotkin Health	$284 - $893	209%
Prime Health Sheriff	$284 - $893	209%
Evolutions Healthcare Systems	$312 - $1,643	230%
Multiplan	$426 - $1,518	314%

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 $1,177.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.