CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Transylvania Regional Hospital, Inc

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $87
Cash Discount Price: $349
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Transylvania Regional Hospital, Inc is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $349. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.91x the Medicare baseline. Located in 90 Hospital Drive Po Box 1116, Brevard, NC.

Cash / Self-Pay

$349

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $349 (367%)

Insurance Median: $87 (91%)

Cash: $349 (367% of Medicare)

Ins. Median: $87 (91% 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
Medcost	$10 - $371	11%
Magellan	$12 - $262	13%
Magellan Behavioral Health	$12 - $262	13%
Aetna	$15 - $315	16%
Multiplan	$16 - $349	17%
Avalon Administrative Services	$18 - $371	19%
Prime Health	$18 - $393	19%
Blue Cross Blue Shield	$66 - $181	69%
United	$67 - $196	70%
Wellcare	$68 - $85	71%
Amerihealth	$69 - $86	72%
Partners Health Management	$69 - $86	72%
Vaya Health	$69 - $86	72%
Apex Health	$70 - $87	74%
Amerihealth Caritas	$143 - $179	150%
Caresource	$154 - $192	162%
Oscar	$159 - $198	167%

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 $349.
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 Transylvania Regional Hospital, Inc 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.