Tennessee / Sycamore Shoals Hospital
CMS certification 440018 · Elizabethton, TN
Sycamore Shoals Hospital: charges and Medicare payments
Sycamore Shoals Hospital reported 257 Medicare inpatient stays across 12 DRGs in 2024. Across them it charged 4.58 times what it was paid — mid-range in Tennessee, number 29 of 65 hospitals with at least 100 stays (state median 4.42×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 64 stays at an average charge of $42,911, 52% below the national average. It also billed 106 outpatient services, charging 8.44 times what Medicare paid.
- 1Medicare inpatient stays 257
- 2Charge ÷ paid, inpatient 4.58×
- 3Rank in TN (highest ratio = 1) 29 of 65
- 4CMS price-transparency actions 0
Inpatient stays
For the 12 DRGs that can be compared with the national average, Sycamore Shoals Hospital charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 64 | $42,911 | -52% | $11,779 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 29 | $83,153 | -11% | $11,946 |
| 291 Heart Failure and Shock with MCC | 22 | $28,637 | -49% | $8,242 |
| 689 Kidney and Urinary Tract Infections with MCC | 22 | $31,743 | -38% | $7,876 |
| 193 Simple Pneumonia and Pleurisy with MCC | 21 | $34,704 | -42% | $8,993 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 19 | $43,534 | -14% | $7,496 |
| 177 Respiratory Infections and Inflammations with MCC | 18 | $64,634 | -8% | $10,701 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 14 | $25,982 | -47% | $7,006 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 13 | $47,390 | -35% | $10,489 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 12 | $18,342 | -51% | $5,478 |
| 690 Kidney and Urinary Tract Infections without MCC | 12 | $30,528 | -19% | $5,712 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 11 | $23,250 | -42% | $5,579 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 42 | $71,625 | $10,437 |
| Comprehensive Observation Services | 26 | $14,936 | $2,200 |
| Level 3 Musculoskeletal Procedures | 13 | $20,906 | $2,678 |
| Level 4 Musculoskeletal Procedures | 13 | $41,254 | $5,919 |
| Level 2 Upper GI Procedures | 12 | $14,948 | $1,574 |
Against the Tennessee average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Sycamore Shoals Hospital charged $42,911 on average, 39% less than the Tennessee average of $70,379, and was paid $11,779 against a state average of $15,065. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Sycamore Shoals Hospital charged $83,153 on average, 0% less than the Tennessee average of $82,835, and was paid $11,946 against a state average of $14,500. For Heart Failure and Shock with MCC (DRG 291), Sycamore Shoals Hospital charged $28,637 on average, 38% less than the Tennessee average of $46,128, and was paid $8,242 against a state average of $10,346. For Kidney and Urinary Tract Infections with MCC (DRG 689), Sycamore Shoals Hospital charged $31,743 on average, 26% less than the Tennessee average of $42,654, and was paid $7,876 against a state average of $9,423. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $71,625 was 9% above the state average of $65,840. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $14,936 was 25% below the state average of $19,917. For Level 3 Musculoskeletal Procedures (outpatient APC 5113), its average charge of $20,906 was 6% below the state average of $22,180. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $41,254 was 2% above the state average of $40,281.
Price-transparency record
No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.