CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Lewisgale Hospital Alleghany

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $422
Cash Discount Price: $528
vs. Medicare Baseline: 4.43x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Lewisgale Hospital Alleghany is $422. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $528. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 4.43x the Medicare baseline. Located in One Arh Lane - Po Box 7, Low Moor, VA.

Cash / Self-Pay

$528

Average discount available for prompt cash payment at this facility.

Insurance Median

$422

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: $528 (555%)

Insurance Median: $422 (443%)

Cash: $528 (555% of Medicare)

Ins. Median: $422 (443% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 443% of the Medicare baseline (a markup of 343%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Lifeworks	$100	105%
Universal Healthcare Group	$116	122%
Virginia Health Network	$185 - $375	194%
Aetna	$190 - $285	200%
United	$201 - $238	211%
Greenvbrier Sporting Club	$317	333%
Corvel	$380	399%
Occunet Workers Comp	$422	443%
Csx Hotels	$422	443%
Health Payors Organization	$449	472%
C&O Employees Hospital Assn	$475	499%
Community Care Network	$475	499%
One Health Plan	$475	499%
Alleghany Highland Community	$475	499%
American Postal Workers Union	$475	499%
Multiplan	$475	499%
4Most	$475	499%
United Behavioral Health	$528	555%

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 $528.
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 Lewisgale Hospital Alleghany 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.