Office visit, established patient (20-29 min)
Facility: St Mary Medical Center
Billing Code: 99213 (CPT)
This hospital's typical commercial price is $67 compared to the $61 fair price benchmark.
2-Star CMS clinical quality rating paired with 1.10× fair market pricing.
Highest price of the 9 PA hospitals we have prices for — worth calling around.
Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.
A fair price for a Office visit, established patient (20-29 min) is about $61 (about 0.6× the $95 Medicare rate). St Mary Medical Center charges insurers about $67, or about $195 in cash — about the fair price. Located in Langhorne, PA.
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
6 of 6 major insurers have a published price at this hospital
Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.
| Insurance company | Price range | vs. Medicare |
|---|---|---|
| UnitedHealthcaremajor | $48 - $97 | 50% |
| Blue Cross Blue Shieldmajor | $35 - $160 | 37% |
| Aetnamajor | $49 - $160 | 51% |
| Cignamajor | $35 - $231 | 37% |
| Humanamajor | $35 - $97 | 37% |
| Kaiser Permanentemajor | $55 - $94 | 58% |
| Ambetter (Centene) | $35 - $409 | 37% |
| AmeriHealth | $55 - $94 | 58% |
| Clover Health | $49 - $97 | 51% |
| GEHA | $48 - $81 | 50% |
| Health Net | $35 - $111 | 37% |
| HealthPartners | $35 - $131 | 37% |
| Meridian | $35 - $97 | 37% |
| Molina | $35 | 37% |
| Oscar Health | $75 - $413 | 79% |
| Paramount | $35 | 37% |
| Presbyterian | $35 - $97 | 37% |
| Tufts Health Plan | $35 | 37% |
| WellMed | $49 - $97 | 51% |
| WellSense | $35 | 37% |
| + 338 smaller / regional plans | $35 - $195 |
Self-Pay How to get the cash price
Insurance Before you use insurance
Estimate your out-of-pocket cost
A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.
Other Procedures at St Mary Medical Center
Compare: Office visit, established patient (20-29 min) at other PA hospitals
- Penn State Health St. Joseph · Reading $25
- UPMC Wellsboro · Wellsboro $39
- Surgical Institute of Reading · Wyomissing $40
- St Luke's Hospital - Upper Bucks Campus · Quakertown $42
- Washington Hospital, The · Washington $42
- St Lukes Hospital · Bethlehem $42
- Lower Bucks Hospital · Bristol $42
- UPMC Greene · Waynesburg $42
Insurance negotiated median for the same procedure, sorted lowest first.
Audit a Bill or Quote at St Mary Medical Center (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $71
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $71).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
St Mary Medical Center's published 45 CFR § 180 self-pay cash rate is $195 (vs. $67 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $61 Fair BaseRate ($95 Medicare)
Your bill ($195) is $134 above the denoised Fair BaseRate ($61) and 2.1× the $95 Medicare rate.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.