Sycamore Shoals Hospital
1501 West Elk Avenue, Elizabethton, TN 37643 · 102 Priced Procedures · 70% Patient Recommendation
Typical commercial prices here are 8% below the fair benchmark (0.92×) after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 0.92× fair market pricing.
Uniform Value Leader · Low-Cost Across Departments
Sycamore Shoals Hospital maintains low, disciplined commercial pricing across both routine shoppable procedures (1.0× Medicare, p50 0.90× Fair BaseRate) and emergency/ancillary services (1.0× Medicare, p75 0.99× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 8% below peer Fair BaseRate (0.92×)
- Self-pay cash beats commercial insurance on 71% of shoppable procedures (99/100 Cash Honesty)
- 2-Star CMS clinical rating with 70% patient recommendation (69/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (18.4% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (0.92× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Commercial insurance median sits at 0.90× Fair BaseRate (1.0× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Specialty infusion drugs (J-codes) average 1.4× Medicare — verify per-unit billing on itemized statements
- Consolidated metro market (HHI 10,000) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Sycamore Shoals Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 102 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Trauma team activation HCPCS Code: G0390 | $2,163 | 1.5× |
| Colonoscopy with biopsy CPT Code: 45380 | $1,140 | 0.9× |
| Injection procedure for pain management HCPCS Code: G0260 | $867 | 1.0× |
| Upper endoscopy with biopsy CPT Code: 43239 | $823 | 0.8× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $818 | 0.8× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $555 | unverified |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $513 | 0.9× |
| MRI, knee or other leg joint CPT Code: 73721 | $478 | 1.3× |
| Psychological testing by technician CPT Code: 96138 | $386 | 1.0× |
| Blood transfusion CPT Code: 36430 | $400 | 0.8× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $336 | 0.8× |
| MRI, brain (no contrast) CPT Code: 70551 | $330 | unverified |
| MRI, lower back (no contrast) CPT Code: 72148 | $330 | unverified |
| Rabies immune globulin HCPCS Code: 90375 | $291 | 0.9× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $233 | 0.9× |
| Neurobehavioral status check CPT Code: 96116 | $202 | 0.9× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $227 | 0.8× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $227 | 0.7× |
| CT scan, head (with contrast) CPT Code: 70460 | $233 | unverified |
| Breathing treatment (nebulizer) CPT Code: 94640 | $199 | 1.0× |
| Psychotherapy session (45 minutes) CPT Code: 90834 | $167 | 1.0× |
| CT scan, head (no contrast) CPT Code: 70450 | $155 | 1.0× |
| Hepatitis B immune globulin HCPCS Code: 90371 | $144 | 1.0× |
| Family therapy session CPT Code: 90847 | $161 | 0.9× |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $167 | 0.9× |
Audit a Bill or Quote at Sycamore Shoals Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $1,216
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (18.4% of gross = $1,216).
Self-Pay Cash Rate ($989) Beats Your Bill
Sycamore Shoals Hospital's published 45 CFR § 180 self-pay cash rate is $989 (vs. $2,163 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $1,453 Fair BaseRate ($1,362 Medicare)
Your bill ($6,591) is $5,138 above the denoised Fair BaseRate ($1,453) and 4.8× the $1,362 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (18.4% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (420 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Sycamore Shoals Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.