CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: HCA Florida Englewood Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $103
Cash Discount Price: $634
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at HCA Florida Englewood Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $634. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.08x the Medicare baseline. Located in 700 Medical Blvd, Englewood, FL.

Cash / Self-Pay

$634

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $634 (666%)

Insurance Median: $103 (108%)

Cash: $634 (666% of Medicare)

Ins. Median: $103 (108% 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	$19 - $38	20%
Blue Cross Blue Shield	$24 - $162	25%
Aetna	$28 - $240	29%
Access 2 Healthcare Physicians Freedom Health	$29 - $57	30%
Access 2 Healthcare Physicians Optimum	$29 - $57	30%
Freedom Health Care	$31 - $62	33%
Optimum Healthcare	$31 - $62	33%
Truli	$34 - $97	36%
Corvel Corporation	$55 - $136	58%
Rockport Healthcare Group	$55 - $136	58%
Prime Health	$56 - $139	59%
Simply Healthcare	$61 - $123	64%
United	$65 - $359	68%
Cigna	$69 - $139	72%
Molina	$76 - $216	80%
Sunshine State Health Plan	$102 - $204	107%
Humana	$112 - $224	118%
Behealthy America	$156 - $311	164%
Evolutions Healthcare Systems	$199 - $735	209%
Healthcare Sarasota	$199 - $399	209%
Plotkin Health	$199 - $399	209%
Prime Health Sheriff	$199 - $399	209%
Multiplan	$299 - $679	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 $634.
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 Englewood 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.