CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Saint Mary's Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $43
  • Cash Discount Price: $189
  • vs. Medicare Baseline: 0.45x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Saint Mary's Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $189. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.45x the Medicare baseline. Located in 56 Franklin Street, Waterbury, CT.
Cash / Self-Pay
$189

Average discount available for prompt cash payment at this facility.

Insurance Median
$43

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: $189 (199%)
Insurance Median: $43 (45%)
Cash: $189 (199% of Medicare)
Ins. Median: $43 (45% 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
Bcn Domestic $10 - $756 11%
Blue Benefit Administrators of Massachusetts $10 - $756 11%
Blue Care Network $10 - $756 11%
Blue Cross Blue Shield $10 - $756 11%
Blue Distinction Transplant $10 - $756 11%
Blue Shield - Ca $10 - $756 11%
Blue Shield - Id (Regence) $10 - $756 11%
Blue Shield - Ny Highmark Northeastern $10 - $756 11%
Blue Shield - Ny Highmark Western $10 - $756 11%
Blue Shield - PA (Highmark) $10 - $756 11%
Blue Shield - Wa (Regence) $10 - $756 11%
Cca Senior Care Options $10 - $255 11%
Champva $10 - $64 11%
Commonwealth Care Alliance $10 - $63 11%
Health Choices $10 - $756 11%
Humana $10 - $64 11%
Kaiser Domestic $10 - $756 11%
Medicaid / KanCare $10 - $103 11%
Medicare (plans) $10 - $255 11%
Pre-Employment $10 - $756 11%
Tricare $10 - $64 11%
Triwest Health Alliance $10 - $64 11%
UnitedHealthcare $10 - $7,184 11%
Veterans Administration $10 - $60 11%
Veterans Eval Services $10 - $64 11%
Wc Domestic $10 - $756 11%
Fallon Health $12 - $127 13%
Us Family Health Plan $12 - $137 13%
Aetna $15 - $250 16%
Andrie Inc $15 - $96 16%
Connecticare $15 - $121 16%
Coventry $15 - $94 16%
East Greenbush Central School District $15 - $96 16%
First Health $15 - $94 16%
Genex Wc $15 - $96 16%
Guardian $15 - $94 16%
Healthscope $15 - $92 16%
Healthsmart Workers Comp $15 - $96 16%
Jag Source $15 - $96 16%
Meritain $15 - $239 16%
New York State Insurance Fund $15 - $96 16%
Njm Insurance Group $15 - $96 16%
Rx Heatlhcomp $15 - $96 16%
Rx Restat $15 - $96 16%
Rx Saif Opdp Wc $15 - $96 16%
Rx Worker's Comp $15 - $96 16%
Wc Accident Fund $15 - $96 16%
Wc Ace $15 - $96 16%
Wc Acs Federal Employees $15 - $96 16%
Wc Acuity $15 - $96 16%
Wc Advantage $15 - $96 16%
Wc Aegis $15 - $96 16%
Wc Aig $15 - $96 16%
Wc Aims $15 - $96 16%
Wc Alaska National Ins $15 - $96 16%
Wc Align Network $15 - $96 16%
Wc Allied $15 - $96 16%
Wc Am Trust N America $15 - $96 16%
Wc American Claims Mgmt $15 - $96 16%
Wc Amerisure $15 - $96 16%
Wc Amtrust $15 - $96 16%
Wc Asu Risk Mgt $15 - $96 16%
Wc Benetech $15 - $96 16%
Wc Berkley Admin $15 - $96 16%
Wc Broadspire $15 - $96 16%
Wc Broward County $15 - $96 16%
Wc Bunch & Associates $15 - $96 16%
Wc California State Comp Ins $15 - $96 16%
Wc California State Ins Fund $15 - $96 16%
Wc Capitol Area Health Consortium $15 - $96 16%
Wc Ccmsi $15 - $96 16%
Wc Chartis $15 - $96 16%
Wc Chubb $15 - $96 16%
Wc Cirma $15 - $96 16%
Wc City of Albany $15 - $96 16%
Wc City of Sioux City $15 - $96 16%
Wc Claims Mgmt Inc $15 - $96 16%
Wc Cna $15 - $96 16%
Wc Comp One Admin C/O Manageability $15 - $96 16%
Wc Compone Admin $15 - $96 16%
Wc Ct Healthcare Trust $15 - $96 16%
Wc Donegal Insurance Group $15 - $96 16%
Wc Emc Insurance Company $15 - $96 16%
Wc Employee Mutual $15 - $96 16%
Wc Enablecomp $15 - $96 16%
Wc Encore Health Network $15 - $96 16%
Wc Erie $15 - $96 16%
Wc Esis $15 - $96 16%
Wc Evolutions $15 - $96 16%
Wc Fcci $15 - $96 16%
Wc Fed Ex $15 - $96 16%
Wc Federal Black Lung $15 - $96 16%
Wc Federated $15 - $96 16%
Wc Finley Occupational Health $15 - $96 16%
Wc First Agency/Occunet $15 - $96 16%
Wc Ford Motor $15 - $96 16%
Wc Fresno Unified Emp $15 - $96 16%
Wc Gallagher Bassett $15 - $96 16%
Wc General Motors $15 - $96 16%
Wc Generic $15 - $96 16%
Wc Genex Care for Ohio $15 - $96 16%
Wc Great West Casualty $15 - $96 16%
Wc Guarantee Insurance $15 - $96 16%
Wc Guard Insurance Company $15 - $96 16%
Wc Hab $15 - $96 16%
Wc Hartford $15 - $96 16%
Wc Hastings $15 - $96 16%
Wc Health Management $15 - $96 16%
Wc Heritage Summit $15 - $96 16%
Wc Hireright $15 - $96 16%
Wc Horizon $15 - $96 16%
Wc Icw Group $15 - $96 16%
Wc Idaho State Ins Fund $15 - $96 16%
Wc Intercare Insurance $15 - $96 16%
Wc Intermountain $15 - $96 16%
Wc Johns Eastern $15 - $96 16%
Wc Kemberton $15 - $96 16%
Wc Key Ins & Benefit Solutions $15 - $96 16%
Wc Liberty Mutual $15 - $96 16%
Wc Mac Risk Management $15 - $96 16%
Wc Massachusetts $15 - $96 16%
Wc Mdia $15 - $96 16%
Wc Meadowbrook Claim $15 - $96 16%
Wc Medical Administrators $15 - $96 16%
Wc Meijers $15 - $96 16%
Wc Memic $15 - $96 16%
Wc Mercy Workcare $15 - $96 16%
Wc Michigan $15 - $96 16%
Wc Michigan Millers Mutual $15 - $96 16%
Wc Mitchell Frankenmuth $15 - $96 16%
Wc Mra $15 - $96 16%
Wc Nationwide $15 - $96 16%
Wc Nca Comp $15 - $96 16%
Wc New York $15 - $96 16%
Wc New York Special Funds $15 - $96 16%
Wc North American Rishces $15 - $96 16%
Wc Northeast Health $15 - $96 16%
Wc Notre Dame $15 - $96 16%
Wc Novanet $15 - $96 16%
Wc O'Hara Corp $15 - $96 16%
Wc Occ Health Allen $15 - $96 16%
Wc Ohio Bureau $15 - $96 16%
Wc One Call Medical $15 - $96 16%
Wc Paradigm $15 - $96 16%
Wc Peerless $15 - $96 16%
Wc Pma $15 - $96 16%
Wc Praxis Health Network $15 - $96 16%
Wc Price Chopper $15 - $96 16%
Wc Procura Management $15 - $96 16%
Wc Qualcare $15 - $96 16%
Wc Quiktrip $15 - $96 16%
Wc Reny Company $15 - $96 16%
Wc Rev Claims $15 - $96 16%
Wc Risico $15 - $96 16%
Wc Rural Mutual $15 - $96 16%
Wc Saif Oregon $15 - $96 16%
Wc Secura $15 - $96 16%
Wc Sedgwick $15 - $96 16%
Wc Sentry $15 - $96 16%
Wc Sheakley Unicomp $15 - $96 16%
Wc Smile Lodge $15 - $96 16%
Wc Society $15 - $96 16%
Wc Srs $15 - $96 16%
Wc Taconic (Mro) $15 - $96 16%
Wc Taconic Farms $15 - $96 16%
Wc Travelers $15 - $96 16%
Wc Triad Group $15 - $96 16%
Wc Tristar $15 - $96 16%
Wc Troy Ny $15 - $96 16%
Wc Tyson $15 - $96 16%
Wc Unified Health Services $15 - $96 16%
Wc United Heartland $15 - $96 16%
Wc Us Dept of Labor $15 - $96 16%
Wc Velocity $15 - $96 16%
Wc Walmart $15 - $96 16%
Wc West Bend $15 - $96 16%
Wc West Bend Mutual/Argent $15 - $96 16%
Wc Winnebago Industries $15 - $96 16%
Wc Yankee Trails $15 - $96 16%
Wc York Risk $15 - $96 16%
Wc Zenith $15 - $96 16%
Wc Zurich $15 - $96 16%
Mass General Brigham Health Plan $16 - $142 17%
Multiplan $16 - $100 17%
Claimdoc $17 - $126 18%
Innovative Health Plan II $17 - $126 18%
Unicare $17 - $756 18%
Wellpoint $17 - $756 18%
Centivo $18 - $120 19%
Health New England $18 - $141 19%
Health Smart $19 - $201 20%
Wc Corvel $19 - $201 20%
Delta Dental Ga $22 - $237 23%
Delta Dental Mi $22 - $237 23%
Delta Dental Mo $22 - $237 23%
Delta Dental Nj $22 - $237 23%
Delta Dental Ny $22 - $237 23%
Delta Dental Oh $22 - $237 23%
Delta Dental Or $22 - $237 23%
Delta Dental PA $22 - $237 23%
Delta Dental VA $22 - $237 23%
Delta Dental Wa $22 - $237 23%
Harvard Pilgrim Healthcare $22 - $7,184 23%
Liberty Dental $22 - $237 23%
Prime Health Services $22 - $144 23%
Tufts Health Plan $22 - $137 23%
Albany County Correctional Facility $43 45%
Ambetter / Centene $43 45%
Amish Mennonite $43 45%
Ascension St. Vincent Public Safety Medical $43 45%
Bcccp-Michigan $43 45%
Bccp $43 45%
Bmc Healthnet $43 45%
Breast Grant-Connecticut $43 45%
Broward County Dept of Health $43 45%
California Health and Wellness $43 45%
Can Community Health Inc $43 45%
Cardinal Innovations Lme $43 45%
Care Connections of Northern Iowa $43 45%
Care Oregon Ohp $43 45%
Cencal Health Plan $43 45%
Cenpatico $43 45%
Chhuny $43 45%
Childrens Comm Health Plan $43 45%
Childrens Medical Services Title 19 $43 45%
Cigna $43 - $9,628 45%
City of Philadelphia $43 45%
Cmh Allegan County $43 45%
Cmh Ausable Valley $43 45%
Cmh Barry County $43 45%
Cmh Bay-Arenac County $43 45%
Cmh Berrien County $43 45%
Cmh Cass County $43 45%
Cmh Central Mi County $43 45%
Cmh Clinton-Eaton-Ingham County $43 45%
Cmh Detroit Wayne Integrated Health Network $43 45%
Cmh Genesee County $43 45%
Cmh Ionia County $43 45%
Cmh Jackson County/Lifeways $43 45%
Cmh Kalamazoo $43 45%
Cmh Kent County $43 45%
Cmh Lenawee County $43 45%
Cmh Livingston County $43 45%
Cmh Macomb $43 45%
Cmh Misc $43 45%
Cmh Monroe County $43 45%
Cmh Montcalm County $43 45%
Cmh Muskegon County $43 45%
Cmh Newaygo County $43 45%
Cmh North Country $43 45%
Cmh Northern Lakes County $43 45%
Cmh Oakland County $43 45%
Cmh Ottawa County $43 45%
Cmh Van Buren County $43 45%
Cmh Washtenaw County $43 45%
Cmh Wayne County/Carelink $43 45%
Cmh Wayne Cty/Com Liv Svcs $43 45%
Cmh West Mi County $43 45%
Community Benefit Health $43 45%
Community Care Behavorial Health $43 45%
Community Care Partners $43 45%
Community Health Choice $43 45%
Connections Csp $43 45%
County Coroner $43 45%
County Funding Generic $43 45%
Covid19 Hrsa Uninsured Testing and Treatment Fund $43 45%
Dean Wi Badgercare $43 45%
Delaware County Department of Health $43 45%
Delaware First Health $43 45%
Dph Tb Program $43 45%
Dscc $43 45%
Eastpointe Lme $43 45%
Family Health Network $43 45%
Freedom First Healthcare $43 45%
Fresno County Ccs $43 45%
Ghc Scw Wi Badgercare $43 45%
Harbor Health $43 45%
Health Safety Net $43 45%
Healthy Blue Ne $43 45%
Hennepin Health $43 45%
Id County Ada $43 45%
Id County Canyon $43 45%
Id County Cat Fund $43 45%
Id County Other $43 45%
Id County Payette $43 45%
Idaho Dept Health and Wellfare $43 45%
Idaho Womens Health Check $43 45%
Indiana Breast Cervical Cancer $43 45%
Inland Empire Health Plan $43 45%
Intercommunity Health Ohp $43 45%
Iowa Total Care $43 45%
Jai Medical System $43 45%
Kern Family Health Plan $43 45%
Keystone First $43 45%
Keystone First Chip $43 45%
La Care Health Plan $43 45%
Lakeland Care Inc $43 45%
Managed Health Services - Indiana $43 45%
Maryland Breast & Cervical Program $43 45%
Maryland Healthy Smiles - Scion Dental $43 45%
Maryland Physicians Care $43 45%
Massachusetts Behavioral Health Partnership $43 45%
Mdwise $43 45%
Medi-Cal $43 45%
Medi-Cal Healthnet $43 45%
Medstar Dc Healthy Family $43 45%
Medstar Md Health Choice $43 45%
Mo Home State Health Plan $43 45%
Molina Centennial Care $43 45%
Nascentia Health Options $43 45%
Nebraska Total Care $43 45%
New York Cancer Services Program $43 45%
Nextlevel Health $43 45%
Oregon Screenwise $43 45%
Pace of Southwest Michigan $43 - $59 45%
Paramount Advantage $43 45%
Parkland Community Health Plan $43 45%
Partners Behavioral Lme $43 45%
Peach State Healthplan $43 45%
Philadelphia County Funding $43 45%
Presbyterian Centennial Care $43 45%
Prestige Health Choice $43 45%
Priority Partners $43 45%
Robert F Sing Program $43 45%
Rx 340B Pass Along $43 45%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $43 45%
Rx Medi-Cal $43 45%
Rx Meridian Rx $43 45%
Ryan White Florida Mssrp $43 45%
Sandhills Center Lme $43 45%
Screening for Life $43 45%
St Joseph County Hlth Dpt $43 45%
Stephenson Cty Health $43 45%
Sunshine State Health Plan $43 45%
Superior Health $43 45%
Tenncare $43 45%
Texas Children's Health Plan $43 45%
Trillium Community Ohp $43 45%
Tufts Health Public Plans $43 45%
Vaya Health Lme $43 45%
Washtenaw Health Plan $43 45%
Wellsense Health Plan $43 45%
Wi Womens Wellness $43 45%
Align Senior Care $59 62%
Ally Align Care Adv $59 62%
American Health Advantage of Idaho $59 62%
American Health Plan $59 62%
Aurora Special Needs $59 62%
Blue Care Network Advantage $59 62%
Blue Shield - De (Highmark) Medciare Advantage $59 62%
Care Dimensions $59 62%
Care Improvement Plus $59 62%
Care Resources Pace $59 62%
Careplus Health Plans $59 62%
Cca - Zing Health $59 62%
Central Valley Medical Services Corp Pace $59 62%
Champion Health Plan McR Advantage $59 62%
Clear Spring Health $59 62%
Clover Health $59 62%
Community Pace at Home $59 62%
Eddy Senior Care-Pace $59 62%
Eddy Seniorcare Pace $59 62%
Elementcare $59 62%
Evercare $59 62%
Everence $59 62%
Gateway Health Plan $59 62%
Genesys Pace of Genesee County $59 62%
Georgia Health Advantage $59 62%
Gold Advantage $59 62%
Gpa Croell Redi Mix $59 62%
Health America Advantra $59 62%
Highmark Health Options Dual Plan $59 62%
Hope Select Pace $59 62%
Horizon Nj Total Care $59 62%
Hudson Headwaters Pace $59 62%
Huron Valley Pace $59 62%
Innovative Integrated Health Community Plans $59 62%
Iowa Health Advantage $59 62%
Johns Hopkins Advantage Md $59 62%
Lasso Healthcare Msa $59 62%
Life St Marys Pace $59 62%
Lifecircles Pace $59 62%
Longevity Health Plan $59 62%
Longevity IPA of Michigan LLC Health Plan Isnp $59 62%
Martins Point Generations Advantage $59 62%
Mass General Brigham McR Adv $59 62%
Medipak Advantage $59 62%
Mercy Life $59 62%
Mercyone Cedar Valley $59 62%
Meridian Complete $59 62%
Michigan Complete Health $59 62%
Nascentia Health Plus $59 62%
New Centry Health Careplus $59 62%
Osu Prime Care Advantage $59 62%
Pace Cny $59 62%
Pace Iowa Immanuel Pathways $59 62%
Pace Southeast $59 62%
Pace-Trinity Health $59 62%
Peak Pace Solutions $59 62%
Perennial Advantage $59 62%
Preferred Care Partners $59 62%
Presbyterian Senior Plan $59 62%
Provider Partners Health Plan of Illinois $59 62%
Provider Partners Health Plan of Indiana $59 62%
Pruitthealth Premier $59 62%
Reliance Community Care Partners Care Resources Pace $59 62%
Rx Allwin $59 62%
Rx Grane Grnmedd $59 62%
Rx Retiree Rx Care $59 62%
Scan Health Plan McR IPA Meritage Oon $59 62%
Secure Horizons Ma Pffs $59 62%
Serenity Pace $59 62%
Siouxland Pace $59 62%
Solis Health Plans $59 62%
Sunnyview-Pace Finance Dept $59 62%
Texan Plus $59 62%
The Health Plan $59 62%
Thome Pace $59 62%
Todays Options $59 62%
Tribute Health Plans $59 62%
Um Health Advantage $59 62%
Union Health Service $59 62%
Welbe Health $59 62%
Wellmed $59 62%
Diversified Administrators $126 132%
Connecticut Dept of Correction $236 248%
1199 National Benefit Fund $239 251%
Allied Benefit Systems $239 251%
Gravie Admin Services $239 251%
Hap $239 251%
Luminare Health $239 251%
Nippon Life Ins $239 251%
Webtpa $239 251%
Geha $7,184 7547%
Allegiance $9,628 10115%
Health Partners $9,628 10115%
Magnacare $9,628 10115%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 56 Franklin Street, Waterbury, CT 06706
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals