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Office visit, new patient, 45-59 min
CPT 99204 · negotiated-rate distribution across hospitals in SC
Hospitals
16
Min
$30.00
Median
$35.70
Max
$161.26
Range multiplier
5.4×
By payer (50 payers with published rates)
| Payer | Hosp. | Rates | Min | Median | Max | Range× |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield | 5 | 96 | $14.70 | $186.31 | $224.25 | 15.3× |
| Medicaid | 1 | 74 | $115.28 | $147.88 | $161.26 | 1.4× |
| Medicare | 1 | 45 | $128.09 | $161.26 | $169.32 | 1.3× |
| UnitedHealthcare | 5 | 41 | $10.90 | $156.42 | $177.18 | 16.3× |
| Aetna | 5 | 35 | $29.10 | $58.80 | $161.26 | 5.5× |
| no fault [114001] | 1 | 28 | $163.85 | $163.85 | $163.85 | 1.0× |
| univera healthcare [100169] | 1 | 18 | $131.19 | $179.78 | $179.78 | 1.4× |
| Molina | 4 | 15 | $13.20 | $332.73 | $332.73 | 25.2× |
| Cigna | 5 | 15 | $25.20 | $67.70 | $233.83 | 9.3× |
| independent health [100165] | 1 | 14 | $174.26 | $174.26 | $174.26 | 1.0× |
| Humana | 5 | 11 | $13.20 | $161.26 | $161.26 | 12.2× |
| WellCare | 1 | 10 | $169.32 | $169.32 | $177.39 | 1.0× |
| federal workers compensation [500100] | 1 | 9 | $128.09 | $163.85 | $163.85 | 1.3× |
| independent health essential [100166] | 1 | 6 | $147.88 | $147.88 | $147.88 | 1.0× |
| amerigroup [350102] | 1 | 6 | $147.88 | $147.88 | $147.88 | 1.0× |
| beacon essential [350122] | 1 | 6 | $115.28 | $153.71 | $153.71 | 1.3× |
| clover insurance company | 3 | 6 | $30.00 | $30.00 | $30.00 | 1.0× |
| fidelis essential [100163] | 1 | 6 | $145.14 | $193.51 | $193.51 | 1.3× |
| hospice [550001] | 1 | 6 | $128.09 | $161.26 | $161.26 | 1.3× |
| TRICARE | 1 | 6 | $161.26 | $161.26 | $161.26 | 1.0× |
| univera healthcare essential [100170] | 1 | 6 | $131.19 | $131.19 | $131.19 | 1.0× |
| VA Health | 1 | 6 | $161.26 | $161.26 | $161.26 | 1.0× |
| absolute total care | 4 | 5 | $13.86 | $18.00 | $26.61 | 1.9× |
| fidelis dual advantage [450120] | 1 | 4 | $169.32 | $169.32 | $169.32 | 1.0× |
| devoted health | 2 | 4 | $25.00 | $25.00 | $25.00 | 1.0× |
| iha first choice [800001] | 1 | 4 | $174.26 | $174.26 | $174.26 | 1.0× |
| Multiplan | 4 | 4 | $85.00 | $90.00 | $90.00 | 1.1× |
| select health | 3 | 3 | $13.20 | $19.84 | $25.34 | 1.9× |
| plotkin health | 3 | 3 | $60.00 | $60.00 | $60.00 | 1.0× |
| medcost - sc | 3 | 3 | $50.44 | $56.53 | $58.51 | 1.2× |
| phcs | 3 | 3 | $90.00 | $90.00 | $90.00 | 1.0× |
| champ va [700002] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| upmc health plan [100181] | 1 | 2 | $160.49 | $160.49 | $160.49 | 1.0× |
| fidelis exchange [100164] | 1 | 2 | $193.51 | $193.51 | $193.51 | 1.0× |
| ghi [100153] | 1 | 2 | $177.39 | $177.39 | $177.39 | 1.0× |
| devoted health plan | 1 | 2 | $25.00 | $25.00 | $25.00 | 1.0× |
| magnacare [100142] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| medcost | 1 | 2 | $56.90 | $65.30 | $73.70 | 1.3× |
| crime victims [100176] | 1 | 2 | $147.88 | $147.88 | $147.88 | 1.0× |
| covid19 hrsa [45013] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| Meritain Health | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| mvp healthcare [100168] | 1 | 2 | $178.25 | $178.25 | $178.25 | 1.0× |
| catholic health life pace [400005] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| seneca nation [450119] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| vna option mltc [350110] | 1 | 2 | $147.88 | $147.88 | $147.88 | 1.0× |
| tuscarora nation [550120] | 1 | 2 | $147.88 | $147.88 | $147.88 | 1.0× |
| beacon health options [100023] | 1 | 2 | $153.71 | $153.71 | $153.71 | 1.0× |
| excellus rochester mcd [350117] | 1 | 2 | $147.88 | $147.88 | $147.88 | 1.0× |
| fallon health [450115] | 1 | 2 | $161.26 | $161.26 | $161.26 | 1.0× |
| prime health | 1 | 1 | $85.00 | $85.00 | $85.00 | 1.0× |
By hospital (top 200 by negotiated median, descending)
| Hospital | City | ST | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| Colleton Medical Center | Walterboro | SC | 24 | $1,828.00 | $1,828.00 | $15.20 | $67.70 | $292.52 |
| East Cooper Regional Medical Center | Mt. Pleasant | SC | 14 | — | $188.70 | $18.80 | $35.70 | $188.70 |
| Hilton Head Hospital | Hilton Head Island | SC | 14 | — | $188.70 | $13.60 | $31.40 | $188.70 |
| Coastal Carolina Medical Center | Hardeeville | SC | 14 | — | $188.70 | $10.90 | $30.00 | $188.70 |
| Mary Black Memorial Hospital | Spartanburg | SC | 39 | $350.00 | $350.00 | $86.41 | $161.26 | $332.73 |
| Roper St. Francis Mt Pleasant Hospit | Mt. Pleasant | SC | 0 | $654.00 | $425.10 | — | — | — |
| Mcleod Loris Seacoast Hospital | Loris | SC | 0 | $697.00 | $494.87 | — | — | — |
| Mcleod Health Cheraw | Cheraw | SC | 0 | $697.00 | $494.87 | — | — | — |
| Mcleod Health Clarendon | Manning | SC | 0 | $697.00 | $494.87 | — | — | — |
| Roper St. Francis Hospital-Berkeley | Summerville | SC | 0 | $344.00 | $223.60 | — | — | — |
| Mcleod Medical Center - Dillon | Dillon | SC | 0 | $697.00 | $494.87 | — | — | — |
| Edgefield County Healthcare | Edgefield | SC | 0 | $332.32 | $199.39 | — | — | — |
| Mcleod Regional Medical Center | Florence | SC | 0 | $697.00 | $494.87 | — | — | — |
| Bon Secours St. Francis Xavier Hospi | Charleston | SC | 0 | $654.00 | $425.10 | — | — | — |
| Self Regional Healthcare | Greenwood | SC | 0 | $332.32 | $199.39 | — | — | — |
| Roper Hospital Inc. | Charleston | SC | 0 | $344.00 | $223.60 | — | — | — |
Median is taken across all payer × plan combinations the hospital publishes. Cash and gross are the latest snapshot values. Range multiplier (max ÷ min) is a quick way to see which hospitals or payers vary the most.