CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Colleton Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $1,257
Cash Discount Price: $2,074
vs. Medicare Baseline: 9.27x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Colleton Medical Center is $1,257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,074. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 9.27x the Medicare baseline. Located in 501 Robertson Boulevard, Walterboro, SC.

Cash / Self-Pay

$2,074

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,257

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: $2,074 (1529%)

Insurance Median: $1,257 (927%)

Cash: $2,074 (1529% of Medicare)

Ins. Median: $1,257 (927% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 927% of the Medicare baseline (a markup of 827%). 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	$74 - $77	55%
Blue Cross Blue Shield	$74 - $2,230	55%
Sc State Employees	$146 - $230	108%
Absolute Total Care	$288 - $422	212%
Aetna	$296 - $1,359	218%
Nhc Advantage	$375 - $446	277%
Pruitt Health	$375 - $446	277%
Select Health	$849 - $1,009	626%
Employers Health Network	$888 - $1,056	655%
United	$888 - $1,246	655%
Value Option	$987 - $1,174	728%
Vocational Rehab	$1,066 - $1,267	786%
Medcost	$1,113 - $1,713	821%
Cigna	$1,275 - $1,516	940%
Humana	$1,283 - $2,112	946%
Mhnet	$1,480 - $1,760	1091%
Evernorth	$1,579 - $1,878	1164%
Multiplan	$1,678 - $1,995	1237%
North American Administrators	$1,678 - $1,995	1237%
Prime Health	$1,678 - $1,995	1237%
First Health	$1,777 - $2,112	1310%
Novanet	$1,777 - $2,112	1310%
United Behavioral Health	$1,974 - $2,347	1456%

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 $2,074.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.