CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Mary Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $54
  • Cash Discount Price: $244
  • vs. Medicare Baseline: 0.40x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Mary Medical Center is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $244. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.40x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.
Cash / Self-Pay
$244

Average discount available for prompt cash payment at this facility.

Insurance Median
$54

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $244 (180%)
Insurance Median: $54 (40%)
Cash: $244 (180% of Medicare)
Ins. Median: $54 (40% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
Aetna $14 - $191 10%
Align Senior Care $14 - $117 10%
Ally Align Care Adv $14 - $117 10%
American Health Advantage Of Idaho $14 - $117 10%
American Health Plan $14 - $117 10%
Aurora Special Needs $14 - $117 10%
Blue Care Network Advantage $14 - $117 10%
Blue Cross Blue Shield $14 - $117 10%
Blue Shield - De (Highmark) Medciare Advantage $14 - $117 10%
Care Dimensions $14 - $117 10%
Care Improvement Plus $14 - $117 10%
Care Resources Pace $14 - $117 10%
Careplus Health Plans $14 - $117 10%
Cca - Zing Health $14 - $117 10%
Cca Senior Care Options $14 - $117 10%
Central Valley Medical Services Corp Pace $14 - $117 10%
Champion Health Plan Mcr Advantage $14 - $117 10%
Cigna $14 - $231 10%
Clear Spring Health $14 - $117 10%
Clover Health $14 - $117 10%
Commonwealth Care Alliance $14 - $117 10%
Community Pace At Home $14 - $117 10%
Eddy Senior Care-Pace $14 - $117 10%
Eddy Seniorcare Pace $14 - $117 10%
Elementcare $14 - $117 10%
Evercare $14 - $119 10%
Everence $14 - $117 10%
Gateway Health Plan $14 - $117 10%
Geha $14 - $104 10%
Genesys Pace Of Genesee County $14 - $117 10%
Georgia Health Advantage $14 - $117 10%
Gold Advantage $14 - $117 10%
Gpa Croell Redi Mix $14 - $117 10%
Highmark Health Options Dual Plan $14 - $117 10%
Hope Select Pace $14 - $117 10%
Horizon Nj Total Care $14 - $117 10%
Hudson Headwaters Pace $14 - $117 10%
Humana $14 - $252 10%
Huron Valley Pace $14 - $117 10%
Innovative Integrated Health Community Plans $14 - $117 10%
Iowa Health Advantage $14 - $117 10%
Johns Hopkins Advantage Md $14 - $117 10%
Lasso Healthcare Msa $14 - $117 10%
Life St Marys Pace $14 - $117 10%
Lifecircles Pace $14 - $117 10%
Longevity Health Plan $14 - $117 10%
Longevity Ipa Of Michigan Llc Health Plan Isnp $14 - $117 10%
Martins Point Generations Advantage $14 - $117 10%
Mass General Brigham Mcr Adv $14 - $117 10%
Medicare (plans) $14 - $413 10%
Medipak Advantage $14 - $117 10%
Mercy Life $14 - $117 10%
Mercyone Cedar Valley $14 - $117 10%
Meridian Complete $14 - $117 10%
Michigan Complete Health $14 - $117 10%
Nascentia Health Plus $14 - $117 10%
New Centry Health Careplus $14 - $117 10%
Osu Prime Care Advantage $14 - $117 10%
Pace Cny $14 - $117 10%
Pace Iowa Immanuel Pathways $14 - $117 10%
Pace Of Southwest Michigan $14 - $117 10%
Pace Southeast $14 - $117 10%
Pace-Trinity Health $14 - $117 10%
Peak Pace Solutions $14 - $117 10%
Perennial Advantage $14 10%
Preferred Care Partners $14 - $117 10%
Presbyterian Senior Plan $14 - $117 10%
Provider Partners Health Plan Of Illinois $14 - $117 10%
Provider Partners Health Plan Of Indiana $14 - $117 10%
Pruitthealth Premier $14 - $117 10%
Reliance Community Care Partners Care Resources Pace $14 - $117 10%
Rx Allwin $14 - $117 10%
Rx Grane Grnmedd $14 - $117 10%
Rx Retiree Rx Care $14 - $117 10%
Scan Health Plan Mcr Ipa Meritage Oon $14 - $117 10%
Secure Horizons Ma Pffs $14 - $117 10%
Serenity Pace $14 - $117 10%
Siouxland Pace $14 - $117 10%
Solis Health Plans $14 - $117 10%
Sunnyview-Pace Finance Dept $14 - $117 10%
Texan Plus $14 - $117 10%
The Health Plan $14 - $117 10%
Thome Pace $14 - $117 10%
Todays Options $14 - $117 10%
Tribute Health Plans $14 - $117 10%
Um Health Advantage $14 - $117 10%
Union Health Service $14 - $117 10%
UnitedHealthcare $14 - $117 10%
Veterans Administration $14 - $119 10%
Welbe Health $14 - $117 10%
Wellmed $14 - $117 10%
Champva $15 - $107 11%
Tricare $15 - $107 11%
Triwest Health Alliance $15 - $107 11%
Us Family Health Plan $15 - $107 11%
Veterans Eval Services $15 - $107 11%
Andrie Inc $16 - $159 12%
East Greenbush Central School District $16 - $159 12%
Genex Wc $16 - $159 12%
Healthsmart Workers Comp $16 - $159 12%
Jag Source $16 - $159 12%
Medicaid / KanCare $16 - $183 12%
New York State Insurance Fund $16 - $159 12%
Njm Insurance Group $16 - $159 12%
Rx Heatlhcomp $16 - $159 12%
Rx Restat $16 - $159 12%
Rx Saif Opdp Wc $16 - $159 12%
Rx Worker'S Comp $16 - $159 12%
Wc Accident Fund $16 - $159 12%
Wc Ace $16 - $159 12%
Wc Acs Federal Employees $16 - $159 12%
Wc Acuity $16 - $159 12%
Wc Advantage $16 - $159 12%
Wc Aegis $16 - $159 12%
Wc Aig $16 - $159 12%
Wc Aims $16 - $159 12%
Wc Alaska National Ins $16 - $159 12%
Wc Align Network $16 - $159 12%
Wc Allied $16 - $159 12%
Wc Am Trust N America $16 - $159 12%
Wc American Claims Mgmt $16 - $159 12%
Wc Amerisure $16 - $159 12%
Wc Amtrust $16 - $159 12%
Wc Asu Risk Mgt $16 - $159 12%
Wc Benetech $16 - $159 12%
Wc Berkley Admin $16 - $159 12%
Wc Broadspire $16 - $159 12%
Wc Broward County $16 - $159 12%
Wc Bunch & Associates $16 - $159 12%
Wc California State Comp Ins $16 - $159 12%
Wc California State Ins Fund $16 - $159 12%
Wc Capitol Area Health Consortium $16 - $159 12%
Wc Ccmsi $16 - $159 12%
Wc Chartis $16 - $159 12%
Wc Chubb $16 - $159 12%
Wc Cirma $16 - $159 12%
Wc City Of Albany $16 - $159 12%
Wc City Of Sioux City $16 - $159 12%
Wc Claims Mgmt Inc $16 - $159 12%
Wc Cna $16 - $159 12%
Wc Comp One Admin C/O Manageability $16 - $159 12%
Wc Compone Admin $16 - $159 12%
Wc Corvel $16 - $159 12%
Wc Ct Healthcare Trust $16 - $159 12%
Wc Donegal Insurance Group $16 - $159 12%
Wc Emc Insurance Company $16 - $159 12%
Wc Employee Mutual $16 - $159 12%
Wc Enablecomp $16 - $159 12%
Wc Encore Health Network $16 - $159 12%
Wc Erie $16 - $159 12%
Wc Esis $16 - $159 12%
Wc Evolutions $16 - $159 12%
Wc Fcci $16 - $159 12%
Wc Fed Ex $16 - $159 12%
Wc Federal Black Lung $16 - $159 12%
Wc Federated $16 - $159 12%
Wc Finley Occupational Health $16 - $159 12%
Wc First Agency/Occunet $16 - $159 12%
Wc Ford Motor $16 - $159 12%
Wc Fresno Unified Emp $16 - $159 12%
Wc Gallagher Bassett $16 - $159 12%
Wc General Motors $16 - $159 12%
Wc Generic $16 - $159 12%
Wc Genex Care For Ohio $16 - $159 12%
Wc Great West Casualty $16 - $159 12%
Wc Guarantee Insurance $16 - $159 12%
Wc Guard Insurance Company $16 - $159 12%
Wc Hab $16 - $159 12%
Wc Hartford $16 - $159 12%
Wc Hastings $16 - $159 12%
Wc Health Management $16 - $159 12%
Wc Heritage Summit $16 - $159 12%
Wc Hireright $16 - $159 12%
Wc Horizon $16 - $159 12%
Wc Icw Group $16 - $159 12%
Wc Idaho State Ins Fund $16 - $159 12%
Wc Intercare Insurance $16 - $159 12%
Wc Intermountain $16 - $159 12%
Wc Johns Eastern $16 - $159 12%
Wc Kemberton $16 - $159 12%
Wc Key Ins & Benefit Solutions $16 - $159 12%
Wc Liberty Mutual $16 - $159 12%
Wc Mac Risk Management $16 - $159 12%
Wc Massachusetts $16 - $159 12%
Wc Mdia $16 - $159 12%
Wc Meadowbrook Claim $16 - $159 12%
Wc Medical Administrators $16 - $159 12%
Wc Meijers $16 - $159 12%
Wc Memic $16 - $159 12%
Wc Mercy Workcare $16 - $159 12%
Wc Michigan $16 - $159 12%
Wc Michigan Millers Mutual $16 - $159 12%
Wc Mitchell Frankenmuth $16 - $159 12%
Wc Mra $16 - $159 12%
Wc Nationwide $16 - $159 12%
Wc Nca Comp $16 - $159 12%
Wc New York $16 - $159 12%
Wc New York Special Funds $16 - $159 12%
Wc North American Rishces $16 - $159 12%
Wc Northeast Health $16 - $159 12%
Wc Notre Dame $16 - $159 12%
Wc Novanet $16 - $159 12%
Wc O'Hara Corp $16 - $159 12%
Wc Occ Health Allen $16 - $159 12%
Wc Ohio Bureau $16 - $159 12%
Wc One Call Medical $16 - $159 12%
Wc Paradigm $16 - $159 12%
Wc Peerless $16 - $159 12%
Wc Pma $16 - $159 12%
Wc Praxis Health Network $16 - $159 12%
Wc Price Chopper $16 - $159 12%
Wc Procura Management $16 - $159 12%
Wc Qualcare $16 - $159 12%
Wc Quiktrip $16 - $159 12%
Wc Reny Company $16 - $159 12%
Wc Rev Claims $16 - $159 12%
Wc Risico $16 - $159 12%
Wc Rural Mutual $16 - $159 12%
Wc Saif Oregon $16 - $159 12%
Wc Secura $16 - $159 12%
Wc Sedgwick $16 - $159 12%
Wc Sentry $16 - $159 12%
Wc Sheakley Unicomp $16 - $159 12%
Wc Smile Lodge $16 - $159 12%
Wc Society $16 - $159 12%
Wc Srs $16 - $159 12%
Wc Taconic (Mro) $16 - $159 12%
Wc Taconic Farms $16 - $159 12%
Wc Travelers $16 - $159 12%
Wc Triad Group $16 - $159 12%
Wc Tristar $16 - $159 12%
Wc Troy Ny $16 - $159 12%
Wc Tyson $16 - $159 12%
Wc Unified Health Services $16 - $159 12%
Wc United Heartland $16 - $159 12%
Wc Us Dept Of Labor $16 - $159 12%
Wc Velocity $16 - $159 12%
Wc Walmart $16 - $159 12%
Wc West Bend $16 - $159 12%
Wc West Bend Mutual/Argent $16 - $159 12%
Wc Winnebago Industries $16 - $159 12%
Wc Yankee Trails $16 - $159 12%
Wc York Risk $16 - $159 12%
Wc Zenith $16 - $159 12%
Wc Zurich $16 - $159 12%
Amerihealth $17 - $109 13%
Bcn Domestic $17 - $109 13%
Blue Benefit Administrators Of Massachusetts $17 - $109 13%
Blue Care Network $17 - $109 13%
Blue Distinction Transplant $17 - $109 13%
Blue Shield - Ca $17 - $109 13%
Blue Shield - Id (Regence) $17 - $109 13%
Blue Shield - Ny Highmark Northeastern $17 - $109 13%
Blue Shield - Ny Highmark Western $17 - $109 13%
Blue Shield - Pa (Highmark) $17 - $236 13%
Blue Shield - Wa (Regence) $17 - $109 13%
Health America Advantra $17 - $143 13%
Health Choices $17 - $109 13%
Kaiser Domestic $17 - $109 13%
Pre-Employment $17 - $109 13%
Wc Domestic $17 - $109 13%
Prime Healthcare $18 - $157 13%
Health Partners $19 - $159 14%
Jefferson Health Plan Commercial $19 - $159 14%
Ambetter / Centene $20 - $409 15%
Oscar $21 - $413 15%
Multiplan $22 - $191 16%
Coventry $27 - $191 20%
Health America $27 - $191 20%
Homestead Health Plans Woods Center $27 - $233 20%
Meritain $27 - $191 20%
Devon Health Services $30 - $252 22%
First Health $30 - $252 22%
Group Pension Administrators $31 - $269 23%
Prime Health Services $31 - $266 23%
Reedman Toll $31 - $269 23%
Three Rivers Provider Network $31 - $266 23%
Albany County Correctional Facility $54 40%
Amish Mennonite $54 40%
Ascension St. Vincent Public Safety Medical $54 40%
Bcccp-Michigan $54 40%
Bccp $54 40%
Bmc Healthnet $54 40%
Breast Grant-Connecticut $54 40%
Broward County Dept Of Health $54 40%
California Health And Wellness $54 40%
Cardinal Innovations Lme $54 40%
Care Connections Of Northern Iowa $54 40%
Care Oregon Ohp $54 40%
Cencal Health Plan $54 40%
Cenpatico $54 40%
Chhuny $54 40%
Childrens Comm Health Plan $54 40%
Childrens Medical Services Title 19 $54 40%
City Of Philadelphia $54 40%
Cmh Allegan County $54 40%
Cmh Ausable Valley $54 40%
Cmh Barry County $54 40%
Cmh Bay-Arenac County $54 40%
Cmh Berrien County $54 40%
Cmh Cass County $54 40%
Cmh Central Mi County $54 40%
Cmh Clinton-Eaton-Ingham County $54 40%
Cmh Detroit Wayne Integrated Health Network $54 40%
Cmh Genesee County $54 40%
Cmh Ionia County $54 40%
Cmh Jackson County/Lifeways $54 40%
Cmh Kalamazoo $54 40%
Cmh Kent County $54 40%
Cmh Lenawee County $54 40%
Cmh Livingston County $54 40%
Cmh Macomb $54 40%
Cmh Misc $54 40%
Cmh Monroe County $54 40%
Cmh Montcalm County $54 40%
Cmh Muskegon County $54 40%
Cmh Newaygo County $54 40%
Cmh North Country $54 40%
Cmh Northern Lakes County $54 40%
Cmh Oakland County $54 40%
Cmh Ottawa County $54 40%
Cmh Van Buren County $54 40%
Cmh Washtenaw County $54 40%
Cmh Wayne County/Carelink $54 40%
Cmh Wayne Cty/Com Liv Svcs $54 40%
Cmh West Mi County $54 40%
Community Benefit Health $54 40%
Community Care Behavorial Health $54 40%
Community Care Partners $54 40%
Community Health Choice $54 - $95 40%
Connections Csp $54 40%
County Coroner $54 40%
County Funding Generic $54 40%
Covid19 Hrsa Uninsured Testing And Treatment Fund $54 40%
Dean Wi Badgercare $54 40%
Delaware County Department Of Health $54 40%
Delaware First Health $54 40%
Delta Dental Nj $54 40%
Dph Tb Program $54 40%
Dscc $54 40%
Eastpointe Lme $54 40%
Family Health Network $54 40%
Freedom First Healthcare $54 40%
Fresno County Ccs $54 40%
Ghc Scw Wi Badgercare $54 40%
Harbor Health $54 40%
Health Safety Net $54 40%
Healthy Blue Ne $54 40%
Hennepin Health $54 40%
Id County Ada $54 40%
Id County Canyon $54 40%
Id County Cat Fund $54 40%
Id County Other $54 40%
Id County Payette $54 40%
Idaho Dept Health And Wellfare $54 40%
Idaho Womens Health Check $54 40%
Indiana Breast Cervical Cancer $54 40%
Inland Empire Health Plan $54 40%
Intercommunity Health Ohp $54 40%
Iowa Total Care $54 40%
Jai Medical System $54 40%
Kern Family Health Plan $54 40%
La Care Health Plan $54 40%
Lakeland Care Inc $54 40%
Managed Health Services - Indiana $54 40%
Maryland Breast & Cervical Program $54 40%
Maryland Healthy Smiles - Scion Dental $54 40%
Maryland Physicians Care $54 40%
Massachusetts Behavioral Health Partnership $54 40%
Mdwise $54 40%
Medi-Cal $54 40%
Medi-Cal Healthnet $54 40%
Medstar Dc Healthy Family $54 40%
Medstar Md Health Choice $54 40%
Mo Home State Health Plan $54 40%
Molina Centennial Care $54 40%
Nascentia Health Options $54 40%
Nebraska Total Care $54 40%
New York Cancer Services Program $54 40%
Nextlevel Health $54 40%
Oregon Screenwise $54 40%
Paramount Advantage $54 40%
Parkland Community Health Plan $54 40%
Partners Behavioral Lme $54 40%
Peach State Healthplan $54 40%
Philadelphia County Funding $54 40%
Presbyterian Centennial Care $54 40%
Prestige Health Choice $54 40%
Priority Partners $54 40%
Robert F Sing Program $54 40%
Rx 340B Pass Along $54 40%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $54 40%
Rx Medi-Cal $54 40%
Rx Meridian Rx $54 40%
Ryan White Florida Mssrp $54 40%
Sandhills Center Lme $54 40%
Screening For Life $54 40%
St Joseph County Hlth Dpt $54 40%
Stephenson Cty Health $54 40%
Sunshine State Health Plan $54 40%
Superior Health $54 40%
Tenncare $54 40%
Texas Children'S Health Plan $54 40%
Trillium Community Ohp $54 40%
Tufts Health Public Plans $54 40%
Vaya Health Lme $54 40%
Washtenaw Health Plan $54 40%
Wellsense Health Plan $54 40%
Wi Womens Wellness $54 40%
Upmc Health Plan $72 53%
Webtpa $72 53%
Keystone First $131 97%
Keystone First Chip $131 97%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Langhorne-Newtown Rd, Langhorne, PA 19047
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals