CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Ephraim McDowell Regional Medical Center

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$69

about 0.7× the $95 Medicare rate · typically $38–$157

modeled estimate · not a bill or quote

Medicare pays $95 Fair price $69 Hospital's list price $274

How we calculate the fair BaseRate →

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna AetnaHumanaKaiser Permanente

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	$176 - $573	185%
Blue Cross Blue Shieldmajor	$120 - $220	126%
Cignamajor	$40 - $72	42%

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, 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 Ephraim McDowell Regional Medical Center 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.

Other Procedures at Ephraim McDowell Regional Medical Center

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

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