CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Lee County Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $44
  • Cash Discount Price: $35
  • vs. Medicare Baseline: 0.46x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Lee County Community Hospital is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.46x the Medicare baseline. Located in 127 Health Care Drive, Pennington Gap, VA.
Cash / Self-Pay
$35

Average discount available for prompt cash payment at this facility.

Insurance Median
$44

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: $35 (37%)
Insurance Median: $44 (46%)
Cash: $35 (37% of Medicare)
Ins. Median: $44 (46% 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.

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
Aetna $34 - $154 36%
Ambetter / Centene $34 36%
Amerigroup $34 - $154 36%
Humana $34 36%
Managed Medicaire $34 36%
Medicare (plans) $34 36%
Mountain Empire Pace $34 36%
Sentara Health $34 - $40 36%
United Mine Workers Of America $34 36%
UnitedHealthcare $34 - $72 36%
Blue Cross Blue Shield $35 - $154 37%
Molina Healthcare $35 37%
Cigna $36 - $154 38%
Devoted Health Plan $36 38%
Nhc Advantage $36 38%
Seven Corners, Inc. $81 85%
First Health Coventry $154 162%
Medcost $154 162%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 127 Health Care Drive, Pennington Gap, VA 24277
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals