CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Colleton Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $792
Cash Discount Price: $1,307
vs. Medicare Baseline: 8.32x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Colleton Medical Center is $792. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,307. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 8.32x the Medicare baseline. Located in 501 Robertson Boulevard, Walterboro, SC.

Cash / Self-Pay

$1,307

Average discount available for prompt cash payment at this facility.

Insurance Median

$792

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: $1,307 (1373%)

Insurance Median: $792 (832%)

Cash: $1,307 (1373% of Medicare)

Ins. Median: $792 (832% 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 832% of the Medicare baseline (a markup of 732%). 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
Blue Choice Health Plan	$49 - $51	51%
Blue Cross Blue Shield	$49 - $1,405	51%
Sc State Employees	$108 - $176	113%
Absolute Total Care	$182 - $266	191%
Aetna	$187 - $856	196%
Nhc Advantage	$237 - $281	249%
Pruitt Health	$237 - $281	249%
Select Health	$535 - $636	562%
Employers Health Network	$560 - $666	588%
United	$560 - $785	588%
Value Option	$622 - $740	653%
Vocational Rehab	$672 - $799	706%
Medcost	$702 - $1,080	737%
Cigna	$804 - $955	845%
Humana	$809 - $1,331	850%
Mhnet	$934 - $1,109	981%
Evernorth	$996 - $1,183	1046%
Multiplan	$1,058 - $1,257	1111%
North American Administrators	$1,058 - $1,257	1111%
Prime Health	$1,058 - $1,257	1111%
First Health	$1,120 - $1,331	1177%
Novanet	$1,120 - $1,331	1177%
United Behavioral Health	$1,245 - $1,479	1308%

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 $1,307.
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 Colleton Medical Center 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.