CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Piedmont Mountainside Hospital Inc

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$105

about 1.1× the $95 Medicare rate · typically $66–$216

modeled estimate · not a bill or quote

What this hospital charges insurers

$259

Well above the fair price

about $154 over the fair price · 2.7× Medicare

Medicare pays $95 Fair price $105 This hospital $259 Cash price $151 Hospital's list price $503

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

Highest price of the 9 GA hospitals we have prices for — worth calling around.

Cheapest $29 Priciest $259

Black dot = this hospital, among the 9 GA hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $105 (about 1.1× the $95 Medicare rate). Piedmont Mountainside Hospital Inc charges insurers about $259, or about $151 in cash — well above the fair price. Located in Jasper, GA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $105. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Aetna✓ Cigna✓ Kaiser Permanente Blue Cross Blue ShieldHumana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$209 - $321	220%
Aetnamajor	$358	376%
Cignamajor	$216 - $302	227%
Kaiser Permanentemajor	$428	450%
+ 3 smaller / regional plans	$342 - $402

Government programs also on file: Medicaid.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 151), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Piedmont Mountainside Hospital Inc is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Piedmont Mountainside Hospital Inc

Compare: Office visit, established patient (20-29 min) at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.