CMS Price Transparency Data
New patient office visit (30-44 min)
Facility: St Mary Medical Center
Billing Code: 99203 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99203
- Insurance Median: $120
- Cash Discount Price: $240
- vs. Medicare Baseline: 1.02x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Mary Medical Center is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.02x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.
Cash / Self-Pay
$240
Average discount available for prompt cash payment at this facility.
Insurance Median
$120
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$117.57
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $240 (204%)
Insurance Median: $120 (102%)
Cash: $240 (204% of Medicare)
Ins. Median: $120 (102% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $117.57 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Albany County Correctional Facility | $54 | 46% |
| Ambetter / Centene | $54 - $174 | 46% |
| Amish Mennonite | $54 | 46% |
| Ascension St. Vincent Public Safety Medical | $54 | 46% |
| Bcccp-Michigan | $54 | 46% |
| Bccp | $54 | 46% |
| Blue Cross Blue Shield | $54 - $178 | 46% |
| Bmc Healthnet | $54 | 46% |
| Breast Grant-Connecticut | $54 | 46% |
| Broward County Dept Of Health | $54 | 46% |
| California Health And Wellness | $54 | 46% |
| Cardinal Innovations Lme | $54 | 46% |
| Care Connections Of Northern Iowa | $54 | 46% |
| Care Oregon Ohp | $54 | 46% |
| Cencal Health Plan | $54 | 46% |
| Cenpatico | $54 | 46% |
| Chhuny | $54 | 46% |
| Childrens Comm Health Plan | $54 | 46% |
| Childrens Medical Services Title 19 | $54 | 46% |
| Cigna | $54 - $204 | 46% |
| City Of Philadelphia | $54 | 46% |
| Cmh Allegan County | $54 | 46% |
| Cmh Ausable Valley | $54 | 46% |
| Cmh Barry County | $54 | 46% |
| Cmh Bay-Arenac County | $54 | 46% |
| Cmh Berrien County | $54 | 46% |
| Cmh Cass County | $54 | 46% |
| Cmh Central Mi County | $54 | 46% |
| Cmh Clinton-Eaton-Ingham County | $54 | 46% |
| Cmh Detroit Wayne Integrated Health Network | $54 | 46% |
| Cmh Genesee County | $54 | 46% |
| Cmh Ionia County | $54 | 46% |
| Cmh Jackson County/Lifeways | $54 | 46% |
| Cmh Kalamazoo | $54 | 46% |
| Cmh Kent County | $54 | 46% |
| Cmh Lenawee County | $54 | 46% |
| Cmh Livingston County | $54 | 46% |
| Cmh Macomb | $54 | 46% |
| Cmh Misc | $54 | 46% |
| Cmh Monroe County | $54 | 46% |
| Cmh Montcalm County | $54 | 46% |
| Cmh Muskegon County | $54 | 46% |
| Cmh Newaygo County | $54 | 46% |
| Cmh North Country | $54 | 46% |
| Cmh Northern Lakes County | $54 | 46% |
| Cmh Oakland County | $54 | 46% |
| Cmh Ottawa County | $54 | 46% |
| Cmh Van Buren County | $54 | 46% |
| Cmh Washtenaw County | $54 | 46% |
| Cmh Wayne County/Carelink | $54 | 46% |
| Cmh Wayne Cty/Com Liv Svcs | $54 | 46% |
| Cmh West Mi County | $54 | 46% |
| Community Benefit Health | $54 | 46% |
| Community Care Behavorial Health | $54 | 46% |
| Community Care Partners | $54 | 46% |
| Community Health Choice | $54 - $98 | 46% |
| Connections Csp | $54 | 46% |
| County Coroner | $54 | 46% |
| County Funding Generic | $54 | 46% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $54 | 46% |
| Dean Wi Badgercare | $54 | 46% |
| Delaware County Department Of Health | $54 | 46% |
| Delaware First Health | $54 | 46% |
| Delta Dental Nj | $54 | 46% |
| Dph Tb Program | $54 | 46% |
| Dscc | $54 | 46% |
| Eastpointe Lme | $54 | 46% |
| Family Health Network | $54 | 46% |
| Freedom First Healthcare | $54 | 46% |
| Fresno County Ccs | $54 | 46% |
| Ghc Scw Wi Badgercare | $54 | 46% |
| Harbor Health | $54 | 46% |
| Health Safety Net | $54 | 46% |
| Healthy Blue Ne | $54 | 46% |
| Hennepin Health | $54 | 46% |
| Humana | $54 - $216 | 46% |
| Id County Ada | $54 | 46% |
| Id County Canyon | $54 | 46% |
| Id County Cat Fund | $54 | 46% |
| Id County Other | $54 | 46% |
| Id County Payette | $54 | 46% |
| Idaho Dept Health And Wellfare | $54 | 46% |
| Idaho Womens Health Check | $54 | 46% |
| Indiana Breast Cervical Cancer | $54 | 46% |
| Inland Empire Health Plan | $54 | 46% |
| Intercommunity Health Ohp | $54 | 46% |
| Iowa Total Care | $54 | 46% |
| Jai Medical System | $54 | 46% |
| Kern Family Health Plan | $54 | 46% |
| La Care Health Plan | $54 | 46% |
| Lakeland Care Inc | $54 | 46% |
| Managed Health Services - Indiana | $54 | 46% |
| Maryland Breast & Cervical Program | $54 | 46% |
| Maryland Healthy Smiles - Scion Dental | $54 | 46% |
| Maryland Physicians Care | $54 | 46% |
| Massachusetts Behavioral Health Partnership | $54 | 46% |
| Mdwise | $54 | 46% |
| Medi-Cal | $54 | 46% |
| Medi-Cal Healthnet | $54 | 46% |
| Medicaid / KanCare | $54 - $112 | 46% |
| Medstar Dc Healthy Family | $54 | 46% |
| Medstar Md Health Choice | $54 | 46% |
| Mo Home State Health Plan | $54 | 46% |
| Molina Centennial Care | $54 | 46% |
| Nascentia Health Options | $54 | 46% |
| Nebraska Total Care | $54 | 46% |
| New York Cancer Services Program | $54 | 46% |
| Nextlevel Health | $54 | 46% |
| Oregon Screenwise | $54 | 46% |
| Pace Of Southwest Michigan | $54 - $120 | 46% |
| Paramount Advantage | $54 | 46% |
| Parkland Community Health Plan | $54 | 46% |
| Partners Behavioral Lme | $54 | 46% |
| Peach State Healthplan | $54 | 46% |
| Philadelphia County Funding | $54 | 46% |
| Presbyterian Centennial Care | $54 | 46% |
| Prestige Health Choice | $54 | 46% |
| Priority Partners | $54 | 46% |
| Robert F Sing Program | $54 | 46% |
| Rx 340B Pass Along | $54 | 46% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $54 | 46% |
| Rx Medi-Cal | $54 | 46% |
| Rx Meridian Rx | $54 | 46% |
| Ryan White Florida Mssrp | $54 | 46% |
| Sandhills Center Lme | $54 | 46% |
| Screening For Life | $54 | 46% |
| St Joseph County Hlth Dpt | $54 | 46% |
| Stephenson Cty Health | $54 | 46% |
| Sunshine State Health Plan | $54 | 46% |
| Superior Health | $54 | 46% |
| Tenncare | $54 | 46% |
| Texas Children'S Health Plan | $54 | 46% |
| Trillium Community Ohp | $54 | 46% |
| Tufts Health Public Plans | $54 | 46% |
| Vaya Health Lme | $54 | 46% |
| Washtenaw Health Plan | $54 | 46% |
| Wellsense Health Plan | $54 | 46% |
| Wi Womens Wellness | $54 | 46% |
| Aetna | $74 - $198 | 63% |
| UnitedHealthcare | $81 - $124 | 69% |
| Champva | $109 | 93% |
| Tricare | $109 | 93% |
| Triwest Health Alliance | $109 | 93% |
| Us Family Health Plan | $109 | 93% |
| Veterans Eval Services | $109 | 93% |
| Keystone First | $112 | 95% |
| Keystone First Chip | $112 | 95% |
| Align Senior Care | $120 | 102% |
| Ally Align Care Adv | $120 | 102% |
| American Health Advantage Of Idaho | $120 | 102% |
| American Health Plan | $120 | 102% |
| Aurora Special Needs | $120 | 102% |
| Blue Care Network Advantage | $120 | 102% |
| Blue Shield - De (Highmark) Medciare Advantage | $120 | 102% |
| Care Dimensions | $120 | 102% |
| Care Improvement Plus | $120 | 102% |
| Care Resources Pace | $120 | 102% |
| Careplus Health Plans | $120 | 102% |
| Cca - Zing Health | $120 | 102% |
| Cca Senior Care Options | $120 | 102% |
| Central Valley Medical Services Corp Pace | $120 | 102% |
| Champion Health Plan Mcr Advantage | $120 | 102% |
| Clear Spring Health | $120 | 102% |
| Clover Health | $120 | 102% |
| Commonwealth Care Alliance | $120 | 102% |
| Community Pace At Home | $120 | 102% |
| Eddy Senior Care-Pace | $120 | 102% |
| Eddy Seniorcare Pace | $120 | 102% |
| Elementcare | $120 | 102% |
| Everence | $120 | 102% |
| Gateway Health Plan | $120 | 102% |
| Genesys Pace Of Genesee County | $120 | 102% |
| Georgia Health Advantage | $120 | 102% |
| Gold Advantage | $120 | 102% |
| Gpa Croell Redi Mix | $120 | 102% |
| Highmark Health Options Dual Plan | $120 | 102% |
| Hope Select Pace | $120 | 102% |
| Horizon Nj Total Care | $120 | 102% |
| Hudson Headwaters Pace | $120 | 102% |
| Huron Valley Pace | $120 | 102% |
| Innovative Integrated Health Community Plans | $120 | 102% |
| Iowa Health Advantage | $120 | 102% |
| Johns Hopkins Advantage Md | $120 | 102% |
| Lasso Healthcare Msa | $120 | 102% |
| Life St Marys Pace | $120 | 102% |
| Lifecircles Pace | $120 | 102% |
| Longevity Health Plan | $120 | 102% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $120 | 102% |
| Martins Point Generations Advantage | $120 | 102% |
| Mass General Brigham Mcr Adv | $120 | 102% |
| Medicare (plans) | $120 - $146 | 102% |
| Medipak Advantage | $120 | 102% |
| Mercy Life | $120 | 102% |
| Mercyone Cedar Valley | $120 | 102% |
| Meridian Complete | $120 | 102% |
| Michigan Complete Health | $120 | 102% |
| Nascentia Health Plus | $120 | 102% |
| New Centry Health Careplus | $120 | 102% |
| Osu Prime Care Advantage | $120 | 102% |
| Pace Cny | $120 | 102% |
| Pace Iowa Immanuel Pathways | $120 | 102% |
| Pace Southeast | $120 | 102% |
| Pace-Trinity Health | $120 | 102% |
| Peak Pace Solutions | $120 | 102% |
| Preferred Care Partners | $120 | 102% |
| Presbyterian Senior Plan | $120 | 102% |
| Provider Partners Health Plan Of Illinois | $120 | 102% |
| Provider Partners Health Plan Of Indiana | $120 | 102% |
| Pruitthealth Premier | $120 | 102% |
| Reliance Community Care Partners Care Resources Pace | $120 | 102% |
| Rx Allwin | $120 | 102% |
| Rx Grane Grnmedd | $120 | 102% |
| Rx Retiree Rx Care | $120 | 102% |
| Scan Health Plan Mcr Ipa Meritage Oon | $120 | 102% |
| Secure Horizons Ma Pffs | $120 | 102% |
| Serenity Pace | $120 | 102% |
| Siouxland Pace | $120 | 102% |
| Solis Health Plans | $120 | 102% |
| Sunnyview-Pace Finance Dept | $120 | 102% |
| Texan Plus | $120 | 102% |
| The Health Plan | $120 | 102% |
| Thome Pace | $120 | 102% |
| Todays Options | $120 | 102% |
| Tribute Health Plans | $120 | 102% |
| Um Health Advantage | $120 | 102% |
| Union Health Service | $120 | 102% |
| Welbe Health | $120 | 102% |
| Wellmed | $120 | 102% |
| Evercare | $122 | 104% |
| Veterans Administration | $122 | 104% |
| Geha | $124 | 105% |
| Amerihealth | $126 | 107% |
| Bcn Domestic | $126 | 107% |
| Blue Benefit Administrators Of Massachusetts | $126 | 107% |
| Blue Care Network | $126 | 107% |
| Blue Distinction Transplant | $126 | 107% |
| Blue Shield - Ca | $126 | 107% |
| Blue Shield - Id (Regence) | $126 | 107% |
| Blue Shield - Ny Highmark Northeastern | $126 | 107% |
| Blue Shield - Ny Highmark Western | $126 | 107% |
| Blue Shield - Pa (Highmark) | $126 | 107% |
| Blue Shield - Wa (Regence) | $126 | 107% |
| Health Choices | $126 | 107% |
| Kaiser Domestic | $126 | 107% |
| Pre-Employment | $126 | 107% |
| Wc Domestic | $126 | 107% |
| Perennial Advantage | $131 | 111% |
| Andrie Inc | $138 | 117% |
| East Greenbush Central School District | $138 | 117% |
| Genex Wc | $138 | 117% |
| Healthsmart Workers Comp | $138 | 117% |
| Jag Source | $138 | 117% |
| New York State Insurance Fund | $138 | 117% |
| Njm Insurance Group | $138 | 117% |
| Rx Heatlhcomp | $138 | 117% |
| Rx Restat | $138 | 117% |
| Rx Saif Opdp Wc | $138 | 117% |
| Rx Worker'S Comp | $138 | 117% |
| Wc Accident Fund | $138 | 117% |
| Wc Ace | $138 | 117% |
| Wc Acs Federal Employees | $138 | 117% |
| Wc Acuity | $138 | 117% |
| Wc Advantage | $138 | 117% |
| Wc Aegis | $138 | 117% |
| Wc Aig | $138 | 117% |
| Wc Aims | $138 | 117% |
| Wc Alaska National Ins | $138 | 117% |
| Wc Align Network | $138 | 117% |
| Wc Allied | $138 | 117% |
| Wc Am Trust N America | $138 | 117% |
| Wc American Claims Mgmt | $138 | 117% |
| Wc Amerisure | $138 | 117% |
| Wc Amtrust | $138 | 117% |
| Wc Asu Risk Mgt | $138 | 117% |
| Wc Benetech | $138 | 117% |
| Wc Berkley Admin | $138 | 117% |
| Wc Broadspire | $138 | 117% |
| Wc Broward County | $138 | 117% |
| Wc Bunch & Associates | $138 | 117% |
| Wc California State Comp Ins | $138 | 117% |
| Wc California State Ins Fund | $138 | 117% |
| Wc Capitol Area Health Consortium | $138 | 117% |
| Wc Ccmsi | $138 | 117% |
| Wc Chartis | $138 | 117% |
| Wc Chubb | $138 | 117% |
| Wc Cirma | $138 | 117% |
| Wc City Of Albany | $138 | 117% |
| Wc City Of Sioux City | $138 | 117% |
| Wc Claims Mgmt Inc | $138 | 117% |
| Wc Cna | $138 | 117% |
| Wc Comp One Admin C/O Manageability | $138 | 117% |
| Wc Compone Admin | $138 | 117% |
| Wc Corvel | $138 | 117% |
| Wc Ct Healthcare Trust | $138 | 117% |
| Wc Donegal Insurance Group | $138 | 117% |
| Wc Emc Insurance Company | $138 | 117% |
| Wc Employee Mutual | $138 | 117% |
| Wc Enablecomp | $138 | 117% |
| Wc Encore Health Network | $138 | 117% |
| Wc Erie | $138 | 117% |
| Wc Esis | $138 | 117% |
| Wc Evolutions | $138 | 117% |
| Wc Fcci | $138 | 117% |
| Wc Fed Ex | $138 | 117% |
| Wc Federal Black Lung | $138 | 117% |
| Wc Federated | $138 | 117% |
| Wc Finley Occupational Health | $138 | 117% |
| Wc First Agency/Occunet | $138 | 117% |
| Wc Ford Motor | $138 | 117% |
| Wc Fresno Unified Emp | $138 | 117% |
| Wc Gallagher Bassett | $138 | 117% |
| Wc General Motors | $138 | 117% |
| Wc Generic | $138 | 117% |
| Wc Genex Care For Ohio | $138 | 117% |
| Wc Great West Casualty | $138 | 117% |
| Wc Guarantee Insurance | $138 | 117% |
| Wc Guard Insurance Company | $138 | 117% |
| Wc Hab | $138 | 117% |
| Wc Hartford | $138 | 117% |
| Wc Hastings | $138 | 117% |
| Wc Health Management | $138 | 117% |
| Wc Heritage Summit | $138 | 117% |
| Wc Hireright | $138 | 117% |
| Wc Horizon | $138 | 117% |
| Wc Icw Group | $138 | 117% |
| Wc Idaho State Ins Fund | $138 | 117% |
| Wc Intercare Insurance | $138 | 117% |
| Wc Intermountain | $138 | 117% |
| Wc Johns Eastern | $138 | 117% |
| Wc Kemberton | $138 | 117% |
| Wc Key Ins & Benefit Solutions | $138 | 117% |
| Wc Liberty Mutual | $138 | 117% |
| Wc Mac Risk Management | $138 | 117% |
| Wc Massachusetts | $138 | 117% |
| Wc Mdia | $138 | 117% |
| Wc Meadowbrook Claim | $138 | 117% |
| Wc Medical Administrators | $138 | 117% |
| Wc Meijers | $138 | 117% |
| Wc Memic | $138 | 117% |
| Wc Mercy Workcare | $138 | 117% |
| Wc Michigan | $138 | 117% |
| Wc Michigan Millers Mutual | $138 | 117% |
| Wc Mitchell Frankenmuth | $138 | 117% |
| Wc Mra | $138 | 117% |
| Wc Nationwide | $138 | 117% |
| Wc Nca Comp | $138 | 117% |
| Wc New York | $138 | 117% |
| Wc New York Special Funds | $138 | 117% |
| Wc North American Rishces | $138 | 117% |
| Wc Northeast Health | $138 | 117% |
| Wc Notre Dame | $138 | 117% |
| Wc Novanet | $138 | 117% |
| Wc O'Hara Corp | $138 | 117% |
| Wc Occ Health Allen | $138 | 117% |
| Wc Ohio Bureau | $138 | 117% |
| Wc One Call Medical | $138 | 117% |
| Wc Paradigm | $138 | 117% |
| Wc Peerless | $138 | 117% |
| Wc Pma | $138 | 117% |
| Wc Praxis Health Network | $138 | 117% |
| Wc Price Chopper | $138 | 117% |
| Wc Procura Management | $138 | 117% |
| Wc Qualcare | $138 | 117% |
| Wc Quiktrip | $138 | 117% |
| Wc Reny Company | $138 | 117% |
| Wc Rev Claims | $138 | 117% |
| Wc Risico | $138 | 117% |
| Wc Rural Mutual | $138 | 117% |
| Wc Saif Oregon | $138 | 117% |
| Wc Secura | $138 | 117% |
| Wc Sedgwick | $138 | 117% |
| Wc Sentry | $138 | 117% |
| Wc Sheakley Unicomp | $138 | 117% |
| Wc Smile Lodge | $138 | 117% |
| Wc Society | $138 | 117% |
| Wc Srs | $138 | 117% |
| Wc Taconic (Mro) | $138 | 117% |
| Wc Taconic Farms | $138 | 117% |
| Wc Travelers | $138 | 117% |
| Wc Triad Group | $138 | 117% |
| Wc Tristar | $138 | 117% |
| Wc Troy Ny | $138 | 117% |
| Wc Tyson | $138 | 117% |
| Wc Unified Health Services | $138 | 117% |
| Wc United Heartland | $138 | 117% |
| Wc Us Dept Of Labor | $138 | 117% |
| Wc Velocity | $138 | 117% |
| Wc Walmart | $138 | 117% |
| Wc West Bend | $138 | 117% |
| Wc West Bend Mutual/Argent | $138 | 117% |
| Wc Winnebago Industries | $138 | 117% |
| Wc Yankee Trails | $138 | 117% |
| Wc York Risk | $138 | 117% |
| Wc Zenith | $138 | 117% |
| Wc Zurich | $138 | 117% |
| Health America Advantra | $146 | 124% |
| Prime Healthcare | $159 | 135% |
| Health Partners | $162 | 138% |
| Jefferson Health Plan Commercial | $162 | 138% |
| Oscar | $181 | 154% |
| Multiplan | $194 | 165% |
| Coventry | $198 | 168% |
| Health America | $198 | 168% |
| Meritain | $198 | 168% |
| Devon Health Services | $216 | 184% |
| First Health | $216 | 184% |
| Prime Health Services | $228 | 194% |
| Three Rivers Provider Network | $228 | 194% |
| Homestead Health Plans Woods Center | $238 | 202% |
| Group Pension Administrators | $240 | 204% |
| Reedman Toll | $240 | 204% |