CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Lucie Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $338
Cash Discount Price: $1,580
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Lucie Medical Center is $338. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,580. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.55x the Medicare baseline. Located in 1800 Se Tiffany Ave, Port Saint Lucie, FL.

Cash / Self-Pay

$1,580

Average discount available for prompt cash payment at this facility.

Insurance Median

$338

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: $1,580 (1660%)

Insurance Median: $338 (355%)

Cash: $1,580 (1660% of Medicare)

Ins. Median: $338 (355% 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 355% of the Medicare baseline (a markup of 255%). 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	$57 - $140	60%
Careworks (Rockport)	$58 - $143	61%
Prime Health	$58 - $143	61%
Aetna	$95 - $535	100%
Blue Cross Blue Shield	$95 - $429	100%
Optimum	$119 - $153	125%
Freedom Health	$153 - $285	161%
Simply Healthcare Plans	$232	244%
Oscar	$262	275%
Health Sun Health Plan	$294 - $380	309%
Simply Healthcare	$324	340%
Molina	$339 - $481	356%
Sunshine State Health Plan	$351 - $454	369%
Cigna	$469 - $625	493%
United Ppo	$606 - $784	637%
United	$620 - $802	651%
Humana	$659 - $713	692%
Avmed	$689	724%
Plotkin Health	$689 - $891	724%
Prime Health Sherriff	$689 - $891	724%
Multiplan	$1,034 - $1,515	1086%

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 $1,580.
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 St Lucie Medical Center 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.