CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Cannon Memorial Hospital
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $133
- Cash Discount Price: $100
- vs. Medicare Baseline: 1.40x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cannon Memorial Hospital is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.40x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.
Cash / Self-Pay
$100
Average discount available for prompt cash payment at this facility.
Insurance Median
$133
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: $100 (105%)
Insurance Median: $133 (140%)
Cash: $100 (105% of Medicare)
Ins. Median: $133 (140% 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 |
|---|---|---|
| Planned Administrators [886] | $40 - $141 | 42% |
| Employee Benefit Management Services [869] | $47 - $101 | 49% |
| Blue Cross Blue Shield | $51 - $261 | 54% |
| Medicaid / KanCare | $51 - $275 | 54% |
| Absolute Total Care [58] | $52 - $249 | 55% |
| Humana | $54 - $249 | 57% |
| Select Health Of Sc [637] | $54 - $237 | 57% |
| Blue Choice Health Plan [922] | $57 - $158 | 60% |
| Preferred Administrators [19] | $58 - $165 | 61% |
| Aetna | $60 - $192 | 63% |
| Devoted Health Alt Payer [9401] | $60 - $142 | 63% |
| Devoted Health [94] | $60 - $142 | 63% |
| Medicare (plans) | $60 - $275 | 63% |
| UnitedHealthcare | $60 - $275 | 63% |
| Vaccn - Va Community Care Network [16] | $60 - $83 | 63% |
| Veterans Administration [633] | $60 - $83 | 63% |
| Absolute Total Care Mcr Plans Alt Payer [4101] | $62 - $170 | 65% |
| Absolute Total Care Mcr Plans [41] | $62 - $170 | 65% |
| Cigna | $62 - $275 | 65% |
| Molina Dual Options Alt Payer [1501] | $62 - $170 | 65% |
| Molina Dual Options [15] | $62 - $170 | 65% |
| Champva [604] | $63 - $86 | 66% |
| First Choice Vip Careplus Alt Payer [3301] | $63 - $152 | 66% |
| First Choice Vip [33] | $63 - $152 | 66% |
| Nhc Advantage Alt Payer [6101] | $63 - $88 | 66% |
| Nhc Advantage [61] | $63 - $88 | 66% |
| Tricare | $63 - $86 | 66% |
| Bright Health [11] | $64 - $92 | 67% |
| Bright Health Alt Payer [1001] | $65 - $94 | 68% |
| Thomas Cooper & Company [315] | $66 - $141 | 69% |
| Nalc Health Benefit Plan [291] | $73 | 77% |
| Geha [302] | $75 - $147 | 79% |
| Golden Rule Ins Co [584] | $75 - $147 | 79% |
| Medcost [206] | $82 - $248 | 86% |
| Phcs [940] | $85 - $185 | 89% |
| Ambetter / Centene | $86 - $119 | 90% |
| First Choice Next [96] | $88 - $121 | 92% |
| Molina Marketplace [97] | $88 - $121 | 92% |
| Mail Handlers Benefit Plan [327] | $97 - $156 | 102% |
| Rural Carrier Benefit Plan [406] | $97 - $156 | 102% |
| Workers Compensation [622] | $97 - $134 | 102% |
| Edison Health Solutions [95] | $106 - $146 | 111% |
| Healthscope [98] | $106 - $146 | 111% |
| Coventry Health [245] | $125 - $198 | 131% |
| Other Hospital Payers [1991] | $150 - $275 | 158% |
| American Continental Ins [778] | $200 - $275 | 210% |
| American Republic Life Ins [722] | $200 - $275 | 210% |
| Business Office [6000] | $200 - $275 | 210% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [17] | $200 - $275 | 210% |
| First Health [946] | $200 - $275 | 210% |
| Guarantee Trust Life Insurance [236] | $200 - $275 | 210% |
| Home Health Infusion Payer [6001] | $200 - $275 | 210% |
| Manhattan Life Ins Co [932] | $200 - $275 | 210% |
| Miscellaneous Commercial [1] | $200 - $275 | 210% |
| New Era Life Ins Co [437] | $200 - $275 | 210% |
| Non-Contracted [22] | $200 - $275 | 210% |
| Physicians Mutual [773] | $200 - $275 | 210% |
| Reference Based Pricing/Limited Plan [21] | $200 - $275 | 210% |
| State Farm Ins Co [373] | $200 - $275 | 210% |
| Sterling Investors Life [244] | $200 - $275 | 210% |
| Supermed/Med Mutual Of Ohio [539] | $200 - $275 | 210% |
| United American Ins Co [277] | $200 - $275 | 210% |