CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Cannon Memorial Hospital
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $156
- Cash Discount Price: $119
- vs. Medicare Baseline: 1.15x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cannon Memorial Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.15x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.
Cash / Self-Pay
$119
Average discount available for prompt cash payment at this facility.
Insurance Median
$156
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $119 (88%)
Insurance Median: $156 (115%)
Cash: $119 (88% of Medicare)
Ins. Median: $156 (115% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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] | $50 - $153 | 37% |
| Employee Benefit Management Services [869] | $69 - $154 | 51% |
| Blue Choice Health Plan [922] | $72 - $172 | 53% |
| Blue Cross Blue Shield | $72 - $285 | 53% |
| Select Health Of Sc [637] | $79 - $237 | 58% |
| Preferred Administrators [19] | $86 - $192 | 63% |
| Vaccn - Va Community Care Network [16] | $89 - $117 | 66% |
| Veterans Administration [633] | $89 - $117 | 66% |
| Champva [604] | $93 - $122 | 69% |
| Nhc Advantage Alt Payer [6101] | $93 - $123 | 69% |
| Nhc Advantage [61] | $93 - $123 | 69% |
| Tricare | $93 - $122 | 69% |
| Thomas Cooper & Company [315] | $96 - $153 | 71% |
| Medicaid / KanCare | $97 - $300 | 72% |
| Absolute Total Care [58] | $99 - $249 | 73% |
| Bright Health [11] | $99 - $135 | 73% |
| Humana | $102 - $249 | 75% |
| Bright Health Alt Payer [1001] | $103 - $133 | 76% |
| Medicare (plans) | $103 - $300 | 76% |
| Cigna | $110 - $300 | 81% |
| Nalc Health Benefit Plan [291] | $110 | 81% |
| Geha [302] | $115 - $160 | 85% |
| Golden Rule Ins Co [584] | $115 - $160 | 85% |
| UnitedHealthcare | $115 - $300 | 85% |
| Medcost [206] | $126 - $270 | 93% |
| Ambetter / Centene | $127 - $168 | 94% |
| Phcs [940] | $127 - $282 | 94% |
| First Choice Next [96] | $129 - $170 | 95% |
| Molina Marketplace [97] | $129 - $170 | 95% |
| Aetna | $142 - $188 | 105% |
| Devoted Health Alt Payer [9401] | $142 | 105% |
| Devoted Health [94] | $142 | 105% |
| Mail Handlers Benefit Plan [327] | $142 - $188 | 105% |
| Rural Carrier Benefit Plan [406] | $142 - $188 | 105% |
| Workers Compensation [622] | $144 - $189 | 106% |
| First Choice Vip Careplus Alt Payer [3301] | $152 | 112% |
| First Choice Vip [33] | $152 | 112% |
| Edison Health Solutions [95] | $155 - $206 | 114% |
| Healthscope [98] | $155 - $206 | 114% |
| Coventry Health [245] | $156 - $216 | 115% |
| Absolute Total Care Mcr Plans Alt Payer [4101] | $177 | 131% |
| Absolute Total Care Mcr Plans [41] | $177 | 131% |
| Molina Dual Options Alt Payer [1501] | $177 | 131% |
| Molina Dual Options [15] | $177 | 131% |
| Other Hospital Payers [1991] | $188 - $300 | 139% |
| American Continental Ins [778] | $250 - $300 | 184% |
| American Republic Life Ins [722] | $250 - $300 | 184% |
| Business Office [6000] | $250 - $300 | 184% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [17] | $250 - $300 | 184% |
| First Health [946] | $250 - $300 | 184% |
| Guarantee Trust Life Insurance [236] | $250 - $300 | 184% |
| Home Health Infusion Payer [6001] | $250 - $300 | 184% |
| Manhattan Life Ins Co [932] | $250 - $300 | 184% |
| Miscellaneous Commercial [1] | $250 - $300 | 184% |
| New Era Life Ins Co [437] | $250 - $300 | 184% |
| Non-Contracted [22] | $250 - $300 | 184% |
| Physicians Mutual [773] | $250 - $300 | 184% |
| Reference Based Pricing/Limited Plan [21] | $250 - $300 | 184% |
| State Farm Ins Co [373] | $250 - $300 | 184% |
| Sterling Investors Life [244] | $250 - $300 | 184% |
| Supermed/Med Mutual Of Ohio [539] | $250 - $300 | 184% |
| United American Ins Co [277] | $250 - $300 | 184% |