CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: St Mary Medical Center
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $67
- Cash Discount Price: $195
- vs. Medicare Baseline: 0.70x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Mary Medical Center is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $195. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.70x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.
Cash / Self-Pay
$195
Average discount available for prompt cash payment at this facility.
Insurance Median
$67
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: $195 (205%)
Insurance Median: $67 (70%)
Cash: $195 (205% of Medicare)
Ins. Median: $67 (70% 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
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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 | $35 | 37% |
| Ambetter / Centene | $35 - $409 | 37% |
| Amish Mennonite | $35 | 37% |
| Ascension St. Vincent Public Safety Medical | $35 | 37% |
| Bcccp-Michigan | $35 | 37% |
| Bccp | $35 | 37% |
| Blue Cross Blue Shield | $35 - $144 | 37% |
| Bmc Healthnet | $35 | 37% |
| Breast Grant-Connecticut | $35 | 37% |
| Broward County Dept Of Health | $35 | 37% |
| California Health And Wellness | $35 | 37% |
| Cardinal Innovations Lme | $35 | 37% |
| Care Connections Of Northern Iowa | $35 | 37% |
| Care Oregon Ohp | $35 | 37% |
| Cencal Health Plan | $35 | 37% |
| Cenpatico | $35 | 37% |
| Chhuny | $35 | 37% |
| Childrens Comm Health Plan | $35 | 37% |
| Childrens Medical Services Title 19 | $35 | 37% |
| Cigna | $35 - $231 | 37% |
| City Of Philadelphia | $35 | 37% |
| Cmh Allegan County | $35 | 37% |
| Cmh Ausable Valley | $35 | 37% |
| Cmh Barry County | $35 | 37% |
| Cmh Bay-Arenac County | $35 | 37% |
| Cmh Berrien County | $35 | 37% |
| Cmh Cass County | $35 | 37% |
| Cmh Central Mi County | $35 | 37% |
| Cmh Clinton-Eaton-Ingham County | $35 | 37% |
| Cmh Detroit Wayne Integrated Health Network | $35 | 37% |
| Cmh Genesee County | $35 | 37% |
| Cmh Ionia County | $35 | 37% |
| Cmh Jackson County/Lifeways | $35 | 37% |
| Cmh Kalamazoo | $35 | 37% |
| Cmh Kent County | $35 | 37% |
| Cmh Lenawee County | $35 | 37% |
| Cmh Livingston County | $35 | 37% |
| Cmh Macomb | $35 | 37% |
| Cmh Misc | $35 | 37% |
| Cmh Monroe County | $35 | 37% |
| Cmh Montcalm County | $35 | 37% |
| Cmh Muskegon County | $35 | 37% |
| Cmh Newaygo County | $35 | 37% |
| Cmh North Country | $35 | 37% |
| Cmh Northern Lakes County | $35 | 37% |
| Cmh Oakland County | $35 | 37% |
| Cmh Ottawa County | $35 | 37% |
| Cmh Van Buren County | $35 | 37% |
| Cmh Washtenaw County | $35 | 37% |
| Cmh Wayne County/Carelink | $35 | 37% |
| Cmh Wayne Cty/Com Liv Svcs | $35 | 37% |
| Cmh West Mi County | $35 | 37% |
| Community Benefit Health | $35 | 37% |
| Community Care Behavorial Health | $35 | 37% |
| Community Care Partners | $35 | 37% |
| Community Health Choice | $35 - $79 | 37% |
| Connections Csp | $35 | 37% |
| County Coroner | $35 | 37% |
| County Funding Generic | $35 | 37% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $35 | 37% |
| Dean Wi Badgercare | $35 | 37% |
| Delaware County Department Of Health | $35 | 37% |
| Delaware First Health | $35 | 37% |
| Delta Dental Nj | $35 | 37% |
| Dph Tb Program | $35 | 37% |
| Dscc | $35 | 37% |
| Eastpointe Lme | $35 | 37% |
| Family Health Network | $35 | 37% |
| Freedom First Healthcare | $35 | 37% |
| Fresno County Ccs | $35 | 37% |
| Ghc Scw Wi Badgercare | $35 | 37% |
| Harbor Health | $35 | 37% |
| Health Safety Net | $35 | 37% |
| Healthy Blue Ne | $35 | 37% |
| Hennepin Health | $35 | 37% |
| Humana | $35 - $97 | 37% |
| Id County Ada | $35 | 37% |
| Id County Canyon | $35 | 37% |
| Id County Cat Fund | $35 | 37% |
| Id County Other | $35 | 37% |
| Id County Payette | $35 | 37% |
| Idaho Dept Health And Wellfare | $35 | 37% |
| Idaho Womens Health Check | $35 | 37% |
| Indiana Breast Cervical Cancer | $35 | 37% |
| Inland Empire Health Plan | $35 | 37% |
| Intercommunity Health Ohp | $35 | 37% |
| Iowa Total Care | $35 | 37% |
| Jai Medical System | $35 | 37% |
| Kern Family Health Plan | $35 | 37% |
| La Care Health Plan | $35 | 37% |
| Lakeland Care Inc | $35 | 37% |
| Managed Health Services - Indiana | $35 | 37% |
| Maryland Breast & Cervical Program | $35 | 37% |
| Maryland Healthy Smiles - Scion Dental | $35 | 37% |
| Maryland Physicians Care | $35 | 37% |
| Massachusetts Behavioral Health Partnership | $35 | 37% |
| Mdwise | $35 | 37% |
| Medi-Cal | $35 | 37% |
| Medi-Cal Healthnet | $35 | 37% |
| Medicaid / KanCare | $35 - $183 | 37% |
| Medstar Dc Healthy Family | $35 | 37% |
| Medstar Md Health Choice | $35 | 37% |
| Mo Home State Health Plan | $35 | 37% |
| Molina Centennial Care | $35 | 37% |
| Nascentia Health Options | $35 | 37% |
| Nebraska Total Care | $35 | 37% |
| New York Cancer Services Program | $35 | 37% |
| Nextlevel Health | $35 | 37% |
| Oregon Screenwise | $35 | 37% |
| Pace Of Southwest Michigan | $35 - $97 | 37% |
| Paramount Advantage | $35 | 37% |
| Parkland Community Health Plan | $35 | 37% |
| Partners Behavioral Lme | $35 | 37% |
| Peach State Healthplan | $35 | 37% |
| Philadelphia County Funding | $35 | 37% |
| Presbyterian Centennial Care | $35 | 37% |
| Prestige Health Choice | $35 | 37% |
| Priority Partners | $35 | 37% |
| Robert F Sing Program | $35 | 37% |
| Rx 340B Pass Along | $35 | 37% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $35 | 37% |
| Rx Medi-Cal | $35 | 37% |
| Rx Meridian Rx | $35 | 37% |
| Ryan White Florida Mssrp | $35 | 37% |
| Sandhills Center Lme | $35 | 37% |
| Screening For Life | $35 | 37% |
| St Joseph County Hlth Dpt | $35 | 37% |
| Stephenson Cty Health | $35 | 37% |
| Sunshine State Health Plan | $35 | 37% |
| Superior Health | $35 | 37% |
| Tenncare | $35 | 37% |
| Texas Children'S Health Plan | $35 | 37% |
| Trillium Community Ohp | $35 | 37% |
| Tufts Health Public Plans | $35 | 37% |
| Vaya Health Lme | $35 | 37% |
| Washtenaw Health Plan | $35 | 37% |
| Wellsense Health Plan | $35 | 37% |
| Wi Womens Wellness | $35 | 37% |
| Geha | $48 - $81 | 50% |
| UnitedHealthcare | $48 - $97 | 50% |
| Aetna | $49 - $160 | 51% |
| Align Senior Care | $49 - $97 | 51% |
| Ally Align Care Adv | $49 - $97 | 51% |
| American Health Advantage Of Idaho | $49 - $97 | 51% |
| American Health Plan | $49 - $97 | 51% |
| Aurora Special Needs | $49 - $97 | 51% |
| Blue Care Network Advantage | $49 - $97 | 51% |
| Blue Shield - De (Highmark) Medciare Advantage | $49 - $97 | 51% |
| Care Dimensions | $49 - $97 | 51% |
| Care Improvement Plus | $49 - $97 | 51% |
| Care Resources Pace | $49 - $97 | 51% |
| Careplus Health Plans | $49 - $97 | 51% |
| Cca - Zing Health | $49 - $97 | 51% |
| Cca Senior Care Options | $49 - $97 | 51% |
| Central Valley Medical Services Corp Pace | $49 - $97 | 51% |
| Champion Health Plan Mcr Advantage | $49 - $97 | 51% |
| Clear Spring Health | $49 - $97 | 51% |
| Clover Health | $49 - $97 | 51% |
| Commonwealth Care Alliance | $49 - $97 | 51% |
| Community Pace At Home | $49 - $97 | 51% |
| Eddy Senior Care-Pace | $49 - $97 | 51% |
| Eddy Seniorcare Pace | $49 - $97 | 51% |
| Elementcare | $49 - $97 | 51% |
| Everence | $49 - $97 | 51% |
| Gateway Health Plan | $49 - $97 | 51% |
| Genesys Pace Of Genesee County | $49 - $97 | 51% |
| Georgia Health Advantage | $49 - $97 | 51% |
| Gold Advantage | $49 - $97 | 51% |
| Gpa Croell Redi Mix | $49 - $97 | 51% |
| Highmark Health Options Dual Plan | $49 - $97 | 51% |
| Hope Select Pace | $49 - $97 | 51% |
| Horizon Nj Total Care | $49 - $97 | 51% |
| Hudson Headwaters Pace | $49 - $97 | 51% |
| Huron Valley Pace | $49 - $97 | 51% |
| Innovative Integrated Health Community Plans | $49 - $97 | 51% |
| Iowa Health Advantage | $49 - $97 | 51% |
| Johns Hopkins Advantage Md | $49 - $97 | 51% |
| Lasso Healthcare Msa | $49 - $97 | 51% |
| Life St Marys Pace | $49 - $97 | 51% |
| Lifecircles Pace | $49 - $97 | 51% |
| Longevity Health Plan | $49 - $97 | 51% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $49 - $97 | 51% |
| Martins Point Generations Advantage | $49 - $97 | 51% |
| Mass General Brigham Mcr Adv | $49 - $97 | 51% |
| Medicare (plans) | $49 - $413 | 51% |
| Medipak Advantage | $49 - $97 | 51% |
| Mercy Life | $49 - $97 | 51% |
| Mercyone Cedar Valley | $49 - $97 | 51% |
| Meridian Complete | $49 - $97 | 51% |
| Michigan Complete Health | $49 - $97 | 51% |
| Nascentia Health Plus | $49 - $97 | 51% |
| New Centry Health Careplus | $49 - $97 | 51% |
| Osu Prime Care Advantage | $49 - $97 | 51% |
| Pace Cny | $49 - $97 | 51% |
| Pace Iowa Immanuel Pathways | $49 - $97 | 51% |
| Pace Southeast | $49 - $97 | 51% |
| Pace-Trinity Health | $49 - $97 | 51% |
| Peak Pace Solutions | $49 - $97 | 51% |
| Preferred Care Partners | $49 - $97 | 51% |
| Presbyterian Senior Plan | $49 - $97 | 51% |
| Provider Partners Health Plan Of Illinois | $49 - $97 | 51% |
| Provider Partners Health Plan Of Indiana | $49 - $97 | 51% |
| Pruitthealth Premier | $49 - $97 | 51% |
| Reliance Community Care Partners Care Resources Pace | $49 - $97 | 51% |
| Rx Allwin | $49 - $97 | 51% |
| Rx Grane Grnmedd | $49 - $97 | 51% |
| Rx Retiree Rx Care | $49 - $97 | 51% |
| Scan Health Plan Mcr Ipa Meritage Oon | $49 - $97 | 51% |
| Secure Horizons Ma Pffs | $49 - $97 | 51% |
| Serenity Pace | $49 - $97 | 51% |
| Siouxland Pace | $49 - $97 | 51% |
| Solis Health Plans | $49 - $97 | 51% |
| Sunnyview-Pace Finance Dept | $49 - $97 | 51% |
| Texan Plus | $49 - $97 | 51% |
| The Health Plan | $49 - $97 | 51% |
| Thome Pace | $49 - $97 | 51% |
| Todays Options | $49 - $97 | 51% |
| Tribute Health Plans | $49 - $97 | 51% |
| Um Health Advantage | $49 - $97 | 51% |
| Union Health Service | $49 - $97 | 51% |
| Welbe Health | $49 - $97 | 51% |
| Wellmed | $49 - $97 | 51% |
| Evercare | $50 - $99 | 53% |
| Veterans Administration | $50 - $99 | 53% |
| Champva | $54 - $89 | 57% |
| Perennial Advantage | $54 - $106 | 57% |
| Tricare | $54 - $89 | 57% |
| Triwest Health Alliance | $54 - $89 | 57% |
| Us Family Health Plan | $54 - $89 | 57% |
| Veterans Eval Services | $54 - $89 | 57% |
| Amerihealth | $55 - $94 | 58% |
| Bcn Domestic | $55 - $94 | 58% |
| Blue Benefit Administrators Of Massachusetts | $55 - $94 | 58% |
| Blue Care Network | $55 - $94 | 58% |
| Blue Distinction Transplant | $55 - $94 | 58% |
| Blue Shield - Ca | $55 - $94 | 58% |
| Blue Shield - Id (Regence) | $55 - $94 | 58% |
| Blue Shield - Ny Highmark Northeastern | $55 - $94 | 58% |
| Blue Shield - Ny Highmark Western | $55 - $94 | 58% |
| Blue Shield - Pa (Highmark) | $55 - $160 | 58% |
| Blue Shield - Wa (Regence) | $55 - $94 | 58% |
| Health Choices | $55 - $94 | 58% |
| Kaiser Domestic | $55 - $94 | 58% |
| Pre-Employment | $55 - $94 | 58% |
| Wc Domestic | $55 - $94 | 58% |
| Health America Advantra | $60 - $118 | 63% |
| Prime Healthcare | $65 - $128 | 68% |
| Andrie Inc | $67 - $111 | 70% |
| East Greenbush Central School District | $67 - $111 | 70% |
| Genex Wc | $67 - $111 | 70% |
| Health Partners | $67 - $131 | 70% |
| Healthsmart Workers Comp | $67 - $111 | 70% |
| Jag Source | $67 - $111 | 70% |
| Jefferson Health Plan Commercial | $67 - $131 | 70% |
| New York State Insurance Fund | $67 - $111 | 70% |
| Njm Insurance Group | $67 - $111 | 70% |
| Rx Heatlhcomp | $67 - $111 | 70% |
| Rx Restat | $67 - $111 | 70% |
| Rx Saif Opdp Wc | $67 - $111 | 70% |
| Rx Worker'S Comp | $67 - $111 | 70% |
| Wc Accident Fund | $67 - $111 | 70% |
| Wc Ace | $67 - $111 | 70% |
| Wc Acs Federal Employees | $67 - $111 | 70% |
| Wc Acuity | $67 - $111 | 70% |
| Wc Advantage | $67 - $111 | 70% |
| Wc Aegis | $67 - $111 | 70% |
| Wc Aig | $67 - $111 | 70% |
| Wc Aims | $67 - $111 | 70% |
| Wc Alaska National Ins | $67 - $111 | 70% |
| Wc Align Network | $67 - $111 | 70% |
| Wc Allied | $67 - $111 | 70% |
| Wc Am Trust N America | $67 - $111 | 70% |
| Wc American Claims Mgmt | $67 - $111 | 70% |
| Wc Amerisure | $67 - $111 | 70% |
| Wc Amtrust | $67 - $111 | 70% |
| Wc Asu Risk Mgt | $67 - $111 | 70% |
| Wc Benetech | $67 - $111 | 70% |
| Wc Berkley Admin | $67 - $111 | 70% |
| Wc Broadspire | $67 - $111 | 70% |
| Wc Broward County | $67 - $111 | 70% |
| Wc Bunch & Associates | $67 - $111 | 70% |
| Wc California State Comp Ins | $67 - $111 | 70% |
| Wc California State Ins Fund | $67 - $111 | 70% |
| Wc Capitol Area Health Consortium | $67 - $111 | 70% |
| Wc Ccmsi | $67 - $111 | 70% |
| Wc Chartis | $67 - $111 | 70% |
| Wc Chubb | $67 - $111 | 70% |
| Wc Cirma | $67 - $111 | 70% |
| Wc City Of Albany | $67 - $111 | 70% |
| Wc City Of Sioux City | $67 - $111 | 70% |
| Wc Claims Mgmt Inc | $67 - $111 | 70% |
| Wc Cna | $67 - $111 | 70% |
| Wc Comp One Admin C/O Manageability | $67 - $111 | 70% |
| Wc Compone Admin | $67 - $111 | 70% |
| Wc Corvel | $67 - $111 | 70% |
| Wc Ct Healthcare Trust | $67 - $111 | 70% |
| Wc Donegal Insurance Group | $67 - $111 | 70% |
| Wc Emc Insurance Company | $67 - $111 | 70% |
| Wc Employee Mutual | $67 - $111 | 70% |
| Wc Enablecomp | $67 - $111 | 70% |
| Wc Encore Health Network | $67 - $111 | 70% |
| Wc Erie | $67 - $111 | 70% |
| Wc Esis | $67 - $111 | 70% |
| Wc Evolutions | $67 - $111 | 70% |
| Wc Fcci | $67 - $111 | 70% |
| Wc Fed Ex | $67 - $111 | 70% |
| Wc Federal Black Lung | $67 - $111 | 70% |
| Wc Federated | $67 - $111 | 70% |
| Wc Finley Occupational Health | $67 - $111 | 70% |
| Wc First Agency/Occunet | $67 - $111 | 70% |
| Wc Ford Motor | $67 - $111 | 70% |
| Wc Fresno Unified Emp | $67 - $111 | 70% |
| Wc Gallagher Bassett | $67 - $111 | 70% |
| Wc General Motors | $67 - $111 | 70% |
| Wc Generic | $67 - $111 | 70% |
| Wc Genex Care For Ohio | $67 - $111 | 70% |
| Wc Great West Casualty | $67 - $111 | 70% |
| Wc Guarantee Insurance | $67 - $111 | 70% |
| Wc Guard Insurance Company | $67 - $111 | 70% |
| Wc Hab | $67 - $111 | 70% |
| Wc Hartford | $67 - $111 | 70% |
| Wc Hastings | $67 - $111 | 70% |
| Wc Health Management | $67 - $111 | 70% |
| Wc Heritage Summit | $67 - $111 | 70% |
| Wc Hireright | $67 - $111 | 70% |
| Wc Horizon | $67 - $111 | 70% |
| Wc Icw Group | $67 - $111 | 70% |
| Wc Idaho State Ins Fund | $67 - $111 | 70% |
| Wc Intercare Insurance | $67 - $111 | 70% |
| Wc Intermountain | $67 - $111 | 70% |
| Wc Johns Eastern | $67 - $111 | 70% |
| Wc Kemberton | $67 - $111 | 70% |
| Wc Key Ins & Benefit Solutions | $67 - $111 | 70% |
| Wc Liberty Mutual | $67 - $111 | 70% |
| Wc Mac Risk Management | $67 - $111 | 70% |
| Wc Massachusetts | $67 - $111 | 70% |
| Wc Mdia | $67 - $111 | 70% |
| Wc Meadowbrook Claim | $67 - $111 | 70% |
| Wc Medical Administrators | $67 - $111 | 70% |
| Wc Meijers | $67 - $111 | 70% |
| Wc Memic | $67 - $111 | 70% |
| Wc Mercy Workcare | $67 - $111 | 70% |
| Wc Michigan | $67 - $111 | 70% |
| Wc Michigan Millers Mutual | $67 - $111 | 70% |
| Wc Mitchell Frankenmuth | $67 - $111 | 70% |
| Wc Mra | $67 - $111 | 70% |
| Wc Nationwide | $67 - $111 | 70% |
| Wc Nca Comp | $67 - $111 | 70% |
| Wc New York | $67 - $111 | 70% |
| Wc New York Special Funds | $67 - $111 | 70% |
| Wc North American Rishces | $67 - $111 | 70% |
| Wc Northeast Health | $67 - $111 | 70% |
| Wc Notre Dame | $67 - $111 | 70% |
| Wc Novanet | $67 - $111 | 70% |
| Wc O'Hara Corp | $67 - $111 | 70% |
| Wc Occ Health Allen | $67 - $111 | 70% |
| Wc Ohio Bureau | $67 - $111 | 70% |
| Wc One Call Medical | $67 - $111 | 70% |
| Wc Paradigm | $67 - $111 | 70% |
| Wc Peerless | $67 - $111 | 70% |
| Wc Pma | $67 - $111 | 70% |
| Wc Praxis Health Network | $67 - $111 | 70% |
| Wc Price Chopper | $67 - $111 | 70% |
| Wc Procura Management | $67 - $111 | 70% |
| Wc Qualcare | $67 - $111 | 70% |
| Wc Quiktrip | $67 - $111 | 70% |
| Wc Reny Company | $67 - $111 | 70% |
| Wc Rev Claims | $67 - $111 | 70% |
| Wc Risico | $67 - $111 | 70% |
| Wc Rural Mutual | $67 - $111 | 70% |
| Wc Saif Oregon | $67 - $111 | 70% |
| Wc Secura | $67 - $111 | 70% |
| Wc Sedgwick | $67 - $111 | 70% |
| Wc Sentry | $67 - $111 | 70% |
| Wc Sheakley Unicomp | $67 - $111 | 70% |
| Wc Smile Lodge | $67 - $111 | 70% |
| Wc Society | $67 - $111 | 70% |
| Wc Srs | $67 - $111 | 70% |
| Wc Taconic (Mro) | $67 - $111 | 70% |
| Wc Taconic Farms | $67 - $111 | 70% |
| Wc Travelers | $67 - $111 | 70% |
| Wc Triad Group | $67 - $111 | 70% |
| Wc Tristar | $67 - $111 | 70% |
| Wc Troy Ny | $67 - $111 | 70% |
| Wc Tyson | $67 - $111 | 70% |
| Wc Unified Health Services | $67 - $111 | 70% |
| Wc United Heartland | $67 - $111 | 70% |
| Wc Us Dept Of Labor | $67 - $111 | 70% |
| Wc Velocity | $67 - $111 | 70% |
| Wc Walmart | $67 - $111 | 70% |
| Wc West Bend | $67 - $111 | 70% |
| Wc West Bend Mutual/Argent | $67 - $111 | 70% |
| Wc Winnebago Industries | $67 - $111 | 70% |
| Wc Yankee Trails | $67 - $111 | 70% |
| Wc York Risk | $67 - $111 | 70% |
| Wc Zenith | $67 - $111 | 70% |
| Wc Zurich | $67 - $111 | 70% |
| Keystone First | $72 - $84 | 76% |
| Keystone First Chip | $72 - $84 | 76% |
| Oscar | $75 - $413 | 79% |
| Multiplan | $96 - $129 | 101% |
| Homestead Health Plans Woods Center | $98 - $192 | 103% |
| Coventry | $99 - $160 | 104% |
| Health America | $99 - $160 | 104% |
| Meritain | $99 - $160 | 104% |
| Group Pension Administrators | $113 - $195 | 119% |
| Reedman Toll | $113 - $195 | 119% |