CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sycamore Shoals Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $95
Cash Discount Price: $36
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sycamore Shoals Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.00x the Medicare baseline. Located in 1501 West Elk Avenue, Elizabethton, TN.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $36 (38%)

Insurance Median: $95 (100%)

Cash: $36 (38% of Medicare)

Ins. Median: $95 (100% 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
Blue Cross Blue Shield	$44 - $174	46%
UnitedHealthcare	$65 - $95	68%
Sentara Health	$67	70%
Medcost	$85	89%
Cigna	$94 - $115	99%
Aetna	$154	162%
First Health Coventry	$182	191%
Seven Corners, Inc.	$242	254%
Wellcare	$242	254%

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 $36.
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 Sycamore Shoals 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.