CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Northwest Florida Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $49
Cash Discount Price: $59
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Northwest Florida Community Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.51x the Medicare baseline. Located in 1360 Brickyard Rd, Chipley, FL.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $59 (62%)

Insurance Median: $49 (51%)

Cash: $59 (62% of Medicare)

Ins. Median: $49 (51% 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
Humana	$11 - $75	12%
Cigna	$14 - $188	15%
Blue_Cross_Nwb	$16 - $212	17%
Blue_Cross_Phs_Ppo	$16 - $212	17%
Medicare (plans)	$22 - $296	23%
United_Healthcare	$22 - $128	23%
Florida_Community_Care	$30	32%
Lighthouse	$30	32%
Sunshine	$30	32%
Wellcare	$30	32%

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 $59.
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 Northwest Florida Community 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.