CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Blount Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $92
Cash Discount Price: $62
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Blount Memorial Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.97x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $62 (65%)

Insurance Median: $92 (97%)

Cash: $62 (65% of Medicare)

Ins. Median: $92 (97% 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
Medicaid / KanCare	$11 - $79	12%
UnitedHealthcare	$11 - $130	12%
Prisma Health Seniorcare Pace - Midlands [5400]	$16 - $77	17%
Prisma Health Seniorcare Pace-Upstate [5200]	$16 - $77	17%
Promise Health Plan Contracted [2401]	$24 - $198	25%
Orangeburg Senior Helping Center Pace [5401]	$28 - $132	29%
Cigna	$38 - $182	40%
Blue Cross Blue Shield	$39 - $185	41%
Bob Jones Univ-Pai [821]	$42 - $198	44%
Preferred Administrators Contracted [2839]	$49 - $231	51%
Atlantic Packaging Contracted [4833]	$52 - $248	55%
Medcost [2940]	$52 - $274	55%
Aps Healthcare System [2981]	$56 - $264	59%
Multiplan/Phcs Contracted [2950]	$62 - $294	65%
Aetna	$63 - $297	66%
Meritain Health Contracted [2200]	$63 - $297	66%
Nippon [2300]	$63 - $297	66%
Vsp Vision Care [2986]	$63 - $297	66%
Tricare	$64 - $120	67%
First Health Contracted [2952]	$65 - $307	68%
Furman Int/Allen University Student [2951]	$65 - $307	68%
Quiktrip-First Health [3067]	$65 - $307	68%
Mvp Health Care [3037]	$66 - $170	69%
Humana	$91 - $125	96%
Medicare (plans)	$91 - $130	96%
Ambetter / Centene	$141 - $196	148%
Consociate Health Contracted [4835]	$200	210%
Fairos/Occunet Contracted [4837]	$209	220%

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 $62.
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 Blount Memorial Hospital 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.