CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Transylvania Regional Hospital, Inc

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $50
Cash Discount Price: $228
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Transylvania Regional Hospital, Inc is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $228. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.43x the Medicare baseline. Located in 90 Hospital Drive Po Box 1116, Brevard, NC.

Cash / Self-Pay

$228

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $228 (194%)

Insurance Median: $50 (43%)

Cash: $228 (194% of Medicare)

Ins. Median: $50 (43% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
Magellan	$12 - $262	10%
Magellan Behavioral Health	$12 - $262	10%
Aetna	$15 - $315	13%
Multiplan	$16 - $349	14%
Avalon Administrative Services	$18 - $371	15%
Medcost	$18 - $371	15%
Prime Health	$18 - $393	15%
Blue Cross Blue Shield	$82 - $181	70%
United	$84 - $196	71%
Wellcare	$85	72%
Amerihealth	$86	73%
Partners Health Management	$86	73%
Vaya Health	$86	73%
Apex Health	$87	74%
Amerihealth Caritas	$179	152%
Caresource	$192	163%
Oscar	$198	168%

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 $228.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Transylvania Regional Hospital, Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.