Office visit, established patient (20-29 min)
Facility: St Luke's Hospital - Carbon Campus
Billing Code: 99213 (CPT)
This hospital's typical commercial price is $42 compared to the $54 fair price benchmark.
5-Star CMS clinical quality rating paired with 0.78× fair market pricing.
A typical price — 0 charge more and 3 charge less, among the 9 PA hospitals compared.
Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.
Note: The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.
A fair price for a Office visit, established patient (20-29 min) is about $54 (about 0.6× the $95 Medicare rate). St Luke's Hospital - Carbon Campus charges insurers about $42, or about $267 in cash — below the fair price — a good deal. Located in Lehighton, PA.
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
4 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 | $93 | 98% |
| Blue Cross Blue Shieldmajor | $42 - $239 | 44% |
| Aetnamajor | $77 - $112 | 81% |
| Cignamajor | $88 | 92% |
| AmeriHealth | $42 | 44% |
| Geisinger | $41 - $91 | 43% |
| Oscar Health | $84 | 88% |
| UPMC Health Plan | $42 - $88 | 44% |
| + 1 smaller / regional plan | $50 |
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 Luke's Hospital - Carbon Campus
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 Luke's Hospital - Carbon Campus (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $117
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 = $117).
Self-Pay Cash Rate ($267) Beats Your Bill
St Luke's Hospital - Carbon Campus's published 45 CFR § 180 self-pay cash rate is $267 (vs. $42 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $54 Fair BaseRate ($95 Medicare)
Your bill ($322) is $268 above the denoised Fair BaseRate ($54) and 3.4× 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.