Office visit, established patient (30-39 min)
Facility: St Mary Medical Center
Billing Code: 99214 (CPT)
This hospital's typical commercial price is $54 compared to the $58 fair price benchmark.
2-Star CMS clinical quality rating paired with 0.93× fair market pricing.
One of the lower prices — 6 of 8 other PA hospitals charge more for the same procedure.
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 (30-39 min) is about $58 (about 0.4× the $136 Medicare rate). St Mary Medical Center charges insurers about $54 — 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 | $14 - $117 | 10% |
| Blue Cross Blue Shieldmajor | $14 - $236 | 10% |
| Aetnamajor | $14 - $191 | 10% |
| Cignamajor | $14 - $231 | 10% |
| Humanamajor | $14 - $252 | 10% |
| Kaiser Permanentemajor | $17 - $109 | 13% |
| Ambetter (Centene) | $20 - $409 | 15% |
| AmeriHealth | $17 - $109 | 13% |
| Clover Health | $14 - $117 | 10% |
| GEHA | $14 - $104 | 10% |
| Health Net | $16 - $159 | 12% |
| HealthPartners | $19 - $159 | 14% |
| Meridian | $14 - $117 | 10% |
| Molina | $54 | 40% |
| Oscar Health | $21 - $413 | 15% |
| Paramount | $54 | 40% |
| Presbyterian | $14 - $117 | 10% |
| Tufts Health Plan | $54 | 40% |
| UPMC Health Plan | $72 | 53% |
| WellMed | $14 - $117 | 10% |
| WellSense | $54 | 40% |
| + 338 smaller / regional plans | $14 - $269 |
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 (30-39 min) at other PA hospitals
- Penn State Health St. Joseph · Reading $25
- Surgical Institute of Reading · Wyomissing $54
- UPMC Altoona · Altoona $57
- Lower Bucks Hospital · Bristol $58
- Roxborough Memorial Hospital · Philadelphia $58
- UPMC Wellsboro · Wellsboro $61
- St Clair Hospital · Pittsburgh $63
- St Luke's Hospital - Upper Bucks Campus · Quakertown $65
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 $75
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 = $75).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask St Mary Medical Center's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $58 Fair BaseRate ($136 Medicare)
Your bill ($207) is $149 above the denoised Fair BaseRate ($58) and 1.5× the $136 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.