CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Leconte Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $102
Cash Discount Price: $51
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Leconte Medical Center is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.07x the Medicare baseline. Located in 742 Middlecreek Road, Sevierville, TN.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $51 (54%)

Insurance Median: $102 (107%)

Cash: $51 (54% of Medicare)

Ins. Median: $102 (107% 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	$23 - $140	24%
Aetna	$43 - $90	45%
Ehn	$49 - $101	51%
UnitedHealthcare	$54 - $237	57%
Cigna	$55 - $172	58%
Ambetter / Centene	$65 - $135	68%
Correctional Medical Services	$65 - $135	68%
Community Services Network	$70 - $146	74%
Usa Managed Care Organization	$76 - $158	80%
Novanet	$81 - $169	85%
Direct Care America	$86 - $180	90%
Medsave Usa	$86 - $180	90%
National Provider Network	$86 - $180	90%
Beech Street	$92 - $191	97%
Ccn Managed Care	$92 - $191	97%
Initial Group	$95 - $198	100%
Galaxy Health Network	$97 - $202	102%

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 $51.
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 Leconte Medical Center 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.