CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Prisma Health Tuomey Hospital

Billing Code: 99203 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$126

about 1.1× the $118 Medicare rate · typically $87–$152

modeled estimate · not a bill or quote

What this hospital charges insurers

$127

About the fair price

about $1 over the fair price · 1.1× Medicare

Medicare pays $118 Fair price $126 This hospital $127 Cash price $113 Hospital's list price $174

How we calculate the fair BaseRate →

How this hospital compares to other SC hospitals

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

Cheapest $79 Priciest $127

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

A fair price for a New patient office visit (30-44 min) is about $126 (about 1.1× the $118 Medicare rate). Prisma Health Tuomey Hospital charges insurers about $127, or about $113 in cash — about the fair price. Located in Sumter, SC.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$42 - $175	36%
Blue Cross Blue Shieldmajor	$41 - $136	35%
Aetnamajor	$47 - $216	40%
Cignamajor	$112 - $131	95%
Humanamajor	$56 - $206	48%
Ambetter (Centene)	$207 - $229	176%
Molina	$118 - $131	100%
WellCare	$118 - $131	100%
+ 15 smaller / regional plans	$17 - $255

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 5 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 113), 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: 99203.

Insurance Before you use insurance

Call your insurance company to confirm Prisma Health Tuomey Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 99203.
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 Prisma Health Tuomey Hospital

Compare: New patient office visit (30-44 min) at other SC hospitals

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