CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: St Francis Hospital
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $63
- Cash Discount Price: $138
- vs. Medicare Baseline: 0.66x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Francis Hospital is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.66x the Medicare baseline. Located in 7Th and Clayton Sts, Wilmington, DE.
Cash / Self-Pay
$138
Average discount available for prompt cash payment at this facility.
Insurance Median
$63
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: $138 (145%)
Insurance Median: $63 (66%)
Cash: $138 (145% of Medicare)
Ins. Median: $63 (66% 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
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 |
|---|---|---|
| Medicaid / KanCare | $42 - $67 | 44% |
| Geha | $45 | 47% |
| UnitedHealthcare | $45 - $63 | 47% |
| Blue Cross Blue Shield | $52 - $74 | 55% |
| Serenity Pace | $56 | 59% |
| Champion Health Plan McR Advantage | $56 | 59% |
| Pace Southeast | $56 | 59% |
| Horizon Nj Total Care | $56 | 59% |
| Innovative Integrated Health Community Plans | $56 | 59% |
| Everence | $56 | 59% |
| American Health Advantage of Idaho | $56 | 59% |
| Gold Advantage | $56 | 59% |
| Hudson Headwaters Pace | $56 | 59% |
| Provider Partners Health Plan of Indiana | $56 | 59% |
| Um Health Advantage | $56 | 59% |
| Pace Iowa Immanuel Pathways | $56 | 59% |
| Eddy Senior Care-Pace | $56 | 59% |
| Humana | $56 - $63 | 59% |
| Preferred Care Partners | $56 | 59% |
| Lifecircles Pace | $56 | 59% |
| Johns Hopkins Advantage Md | $56 | 59% |
| Gpa Croell Redi Mix | $56 | 59% |
| Longevity IPA of Michigan LLC Health Plan Isnp | $56 | 59% |
| Welbe Health | $56 | 59% |
| Longevity Health Plan | $56 | 59% |
| Align Senior Care | $56 | 59% |
| Evercare | $56 | 59% |
| Pace-Trinity Health | $56 | 59% |
| Elementcare | $56 | 59% |
| Mass General Brigham McR Adv | $56 | 59% |
| Clear Spring Health | $56 | 59% |
| Eddy Seniorcare Pace | $56 | 59% |
| Central Valley Medical Services Corp Pace | $56 | 59% |
| Union Health Service | $56 | 59% |
| Medicare (plans) | $56 - $63 | 59% |
| Clover Health | $56 | 59% |
| Michigan Complete Health | $56 | 59% |
| Iowa Health Advantage | $56 | 59% |
| Reliance Community Care Partners Care Resources Pace | $56 | 59% |
| American Health Plan | $56 | 59% |
| Life St Marys Pace | $56 | 59% |
| Huron Valley Pace | $56 | 59% |
| Texan Plus | $56 | 59% |
| Siouxland Pace | $56 | 59% |
| Care Dimensions | $56 | 59% |
| Careplus Health Plans | $56 | 59% |
| The Health Plan | $56 | 59% |
| Hope Select Pace | $56 | 59% |
| New Centry Health Careplus | $56 | 59% |
| Wellmed | $56 | 59% |
| Todays Options | $56 | 59% |
| Meridian Complete | $56 | 59% |
| Health America Advantra | $56 | 59% |
| Presbyterian Senior Plan | $56 | 59% |
| Pruitthealth Premier | $56 | 59% |
| Rx Grane Grnmedd | $56 | 59% |
| Highmark Health Options Dual Plan | $56 | 59% |
| Care Improvement Plus | $56 | 59% |
| Provider Partners Health Plan of Illinois | $56 | 59% |
| Mercyone Cedar Valley | $56 | 59% |
| Blue Care Network Advantage | $56 | 59% |
| Rx Retiree Rx Care | $56 | 59% |
| Osu Prime Care Advantage | $56 | 59% |
| Tribute Health Plans | $56 | 59% |
| Genesys Pace of Genesee County | $56 | 59% |
| Aurora Special Needs | $56 | 59% |
| Georgia Health Advantage | $56 | 59% |
| Peak Pace Solutions | $56 | 59% |
| Cca - Zing Health | $56 | 59% |
| Cca Senior Care Options | $56 | 59% |
| Mercy Life | $56 | 59% |
| Medipak Advantage | $56 | 59% |
| Scan Health Plan McR IPA Meritage Oon | $56 | 59% |
| Cigna | $56 - $114 | 59% |
| Martins Point Generations Advantage | $56 | 59% |
| Commonwealth Care Alliance | $56 | 59% |
| Nascentia Health Plus | $56 | 59% |
| Aetna | $56 - $118 | 59% |
| Thome Pace | $56 | 59% |
| Solis Health Plans | $56 | 59% |
| Rx Allwin | $56 | 59% |
| Lasso Healthcare Msa | $56 | 59% |
| Pace Cny | $56 | 59% |
| Ally Align Care Adv | $56 | 59% |
| Perennial Advantage | $56 | 59% |
| Sunnyview-Pace Finance Dept | $56 | 59% |
| Community Pace at Home | $56 | 59% |
| Care Resources Pace | $56 | 59% |
| Secure Horizons Ma Pffs | $56 | 59% |
| Gateway Health Plan | $56 | 59% |
| Pace of Southwest Michigan | $56 - $63 | 59% |
| Veterans Administration | $57 | 60% |
| Blue Shield - De (Highmark) Medciare Advantage | $59 | 62% |
| First Health | $60 | 63% |
| Champva | $61 | 64% |
| Veterans Eval Services | $61 | 64% |
| Us Family Health Plan | $61 | 64% |
| Tricare | $61 | 64% |
| Triwest Health Alliance | $61 | 64% |
| Delaware County Department of Health | $63 | 66% |
| La Care Health Plan | $63 | 66% |
| Dph Tb Program | $63 | 66% |
| Cmh Central Mi County | $63 | 66% |
| Cmh Washtenaw County | $63 | 66% |
| Childrens Medical Services Title 19 | $63 | 66% |
| Eastpointe Lme | $63 | 66% |
| Cmh West Mi County | $63 | 66% |
| City of Philadelphia | $63 | 66% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $63 | 66% |
| New York Cancer Services Program | $63 | 66% |
| Partners Behavioral Lme | $63 | 66% |
| Inland Empire Health Plan | $63 | 66% |
| Cmh Oakland County | $63 | 66% |
| Tufts Health Public Plans | $63 | 66% |
| Tenncare | $63 | 66% |
| Family Health Network | $63 | 66% |
| Id County Ada | $63 | 66% |
| Rx 340B Pass Along | $63 | 66% |
| Cmh Muskegon County | $63 | 66% |
| Cmh Ionia County | $63 | 66% |
| Lakeland Care Inc | $63 | 66% |
| Wi Womens Wellness | $63 | 66% |
| Nextlevel Health | $63 | 66% |
| Cmh Wayne County/Carelink | $63 | 66% |
| Freedom First Healthcare | $63 | 66% |
| Cmh Kalamazoo | $63 | 66% |
| Community Care Partners | $63 | 66% |
| Maryland Physicians Care | $63 | 66% |
| Bmc Healthnet | $63 | 66% |
| Molina Centennial Care | $63 | 66% |
| Connections Csp | $63 | 66% |
| Ambetter / Centene | $63 - $80 | 66% |
| Ascension St. Vincent Public Safety Medical | $63 | 66% |
| Cmh Van Buren County | $63 | 66% |
| Indiana Breast Cervical Cancer | $63 | 66% |
| Chhuny | $63 | 66% |
| Hennepin Health | $63 | 66% |
| Community Care Behavorial Health | $63 | 66% |
| Bcccp-Michigan | $63 | 66% |
| Peach State Healthplan | $63 | 66% |
| Bccp | $63 | 66% |
| Cmh Lenawee County | $63 | 66% |
| Ryan White Florida Mssrp | $63 | 66% |
| Cmh Berrien County | $63 | 66% |
| Sunshine State Health Plan | $63 | 66% |
| Care Oregon Ohp | $63 | 66% |
| Texas Children's Health Plan | $63 | 66% |
| Idaho Dept Health and Wellfare | $63 | 66% |
| Cmh Barry County | $63 | 66% |
| Sandhills Center Lme | $63 | 66% |
| Keystone First Chip | $63 | 66% |
| Cmh Ausable Valley | $63 | 66% |
| Cmh Detroit Wayne Integrated Health Network | $63 | 66% |
| Managed Health Services - Indiana | $63 | 66% |
| Cmh Kent County | $63 | 66% |
| Id County Other | $63 | 66% |
| Stephenson Cty Health | $63 | 66% |
| Fresno County Ccs | $63 | 66% |
| Cmh Ottawa County | $63 | 66% |
| County Funding Generic | $63 | 66% |
| Harbor Health | $63 | 66% |
| Medstar Dc Healthy Family | $63 | 66% |
| County Coroner | $63 | 66% |
| Rx Medi-Cal | $63 | 66% |
| Healthy Blue Ne | $63 | 66% |
| Mo Home State Health Plan | $63 | 66% |
| Iowa Total Care | $63 | 66% |
| Priority Partners | $63 | 66% |
| Wellsense Health Plan | $63 | 66% |
| Medi-Cal Healthnet | $63 | 66% |
| Mdwise | $63 | 66% |
| Washtenaw Health Plan | $63 | 66% |
| Nascentia Health Options | $63 | 66% |
| Cmh Macomb | $63 | 66% |
| Cmh Newaygo County | $63 | 66% |
| Id County Cat Fund | $63 | 66% |
| Ghc Scw Wi Badgercare | $63 | 66% |
| Cmh Genesee County | $63 | 66% |
| Cardinal Innovations Lme | $63 | 66% |
| Cmh Allegan County | $63 | 66% |
| Cmh Jackson County/Lifeways | $63 | 66% |
| Paramount Advantage | $63 | 66% |
| Screening for Life | $63 | 66% |
| Cmh Cass County | $63 | 66% |
| Dscc | $63 | 66% |
| Superior Health | $63 | 66% |
| Medstar Md Health Choice | $63 | 66% |
| Jai Medical System | $63 | 66% |
| Cmh Clinton-Eaton-Ingham County | $63 | 66% |
| Cencal Health Plan | $63 | 66% |
| Breast Grant-Connecticut | $63 | 66% |
| Childrens Comm Health Plan | $63 | 66% |
| Amish Mennonite | $63 | 66% |
| Community Health Choice | $63 | 66% |
| Cmh Livingston County | $63 | 66% |
| Cmh Northern Lakes County | $63 | 66% |
| Philadelphia County Funding | $63 | 66% |
| Cmh Misc | $63 | 66% |
| Idaho Womens Health Check | $63 | 66% |
| Keystone First | $63 | 66% |
| Kern Family Health Plan | $63 | 66% |
| Intercommunity Health Ohp | $63 | 66% |
| Dean Wi Badgercare | $63 | 66% |
| Broward County Dept of Health | $63 | 66% |
| Vaya Health Lme | $63 | 66% |
| Id County Canyon | $63 | 66% |
| California Health and Wellness | $63 | 66% |
| Maryland Healthy Smiles - Scion Dental | $63 | 66% |
| Cmh Montcalm County | $63 | 66% |
| Id County Payette | $63 | 66% |
| Community Benefit Health | $63 | 66% |
| Albany County Correctional Facility | $63 | 66% |
| Oregon Screenwise | $63 | 66% |
| Delta Dental Nj | $63 | 66% |
| Prestige Health Choice | $63 | 66% |
| Health Safety Net | $63 | 66% |
| St Joseph County Hlth Dpt | $63 | 66% |
| Cmh Monroe County | $63 | 66% |
| Covid19 Hrsa Uninsured Testing and Treatment Fund | $63 | 66% |
| Maryland Breast & Cervical Program | $63 | 66% |
| Cmh Wayne Cty/Com Liv Svcs | $63 | 66% |
| Robert F Sing Program | $63 | 66% |
| Cmh North Country | $63 | 66% |
| Care Connections of Northern Iowa | $63 | 66% |
| Massachusetts Behavioral Health Partnership | $63 | 66% |
| Presbyterian Centennial Care | $63 | 66% |
| Cenpatico | $63 | 66% |
| Trillium Community Ohp | $63 | 66% |
| Rx Meridian Rx | $63 | 66% |
| Nebraska Total Care | $63 | 66% |
| Medi-Cal | $63 | 66% |
| Parkland Community Health Plan | $63 | 66% |
| Cmh Bay-Arenac County | $63 | 66% |
| Blue Shield - Wa (Regence) | $71 | 75% |
| Blue Shield - Ny Highmark Western | $71 | 75% |
| Blue Care Network | $71 | 75% |
| Health Choices | $71 | 75% |
| Wc Domestic | $71 | 75% |
| Blue Benefit Administrators of Massachusetts | $71 | 75% |
| Blue Shield - PA (Highmark) | $71 | 75% |
| Bcn Domestic | $71 | 75% |
| Pre-Employment | $71 | 75% |
| Blue Shield - Ny Highmark Northeastern | $71 | 75% |
| Kaiser Domestic | $71 | 75% |
| Blue Shield - Id (Regence) | $71 | 75% |
| Blue Shield - Ca | $71 | 75% |
| Blue Distinction Transplant | $71 | 75% |
| Delaware First Health | $75 | 79% |
| Andrie Inc | $82 | 86% |
| Wc Nca Comp | $82 | 86% |
| Wc Mra | $82 | 86% |
| Healthsmart Workers Comp | $82 | 86% |
| Wc Asu Risk Mgt | $82 | 86% |
| Wc Aims | $82 | 86% |
| Wc Winnebago Industries | $82 | 86% |
| Wc Northeast Health | $82 | 86% |
| Jag Source | $82 | 86% |
| Wc Quiktrip | $82 | 86% |
| Wc City of Albany | $82 | 86% |
| Wc Liberty Mutual | $82 | 86% |
| Wc O'Hara Corp | $82 | 86% |
| Wc North American Rishces | $82 | 86% |
| Wc Ohio Bureau | $82 | 86% |
| Wc Smile Lodge | $82 | 86% |
| Wc Heritage Summit | $82 | 86% |
| New York State Insurance Fund | $82 | 86% |
| Wc Memic | $82 | 86% |
| Rx Saif Opdp Wc | $82 | 86% |
| Wc Pma | $82 | 86% |
| Wc California State Ins Fund | $82 | 86% |
| Wc Horizon | $82 | 86% |
| Wc Aegis | $82 | 86% |
| Wc City of Sioux City | $82 | 86% |
| Wc Encore Health Network | $82 | 86% |
| Wc Broadspire | $82 | 86% |
| Wc Idaho State Ins Fund | $82 | 86% |
| Wc General Motors | $82 | 86% |
| Wc Notre Dame | $82 | 86% |
| Wc Finley Occupational Health | $82 | 86% |
| Wc First Agency/Occunet | $82 | 86% |
| Wc Walmart | $82 | 86% |
| Wc Berkley Admin | $82 | 86% |
| Wc Amtrust | $82 | 86% |
| Wc West Bend | $82 | 86% |
| Wc Allied | $82 | 86% |
| Wc West Bend Mutual/Argent | $82 | 86% |
| Wc Novanet | $82 | 86% |
| Wc Triad Group | $82 | 86% |
| Wc Occ Health Allen | $82 | 86% |
| Wc Hireright | $82 | 86% |
| Wc Michigan | $82 | 86% |
| Wc Hab | $82 | 86% |
| Wc Acuity | $82 | 86% |
| Wc Federal Black Lung | $82 | 86% |
| Wc Tyson | $82 | 86% |
| Wc Acs Federal Employees | $82 | 86% |
| Wc One Call Medical | $82 | 86% |
| Wc Fresno Unified Emp | $82 | 86% |
| Wc Mdia | $82 | 86% |
| Wc Esis | $82 | 86% |
| Wc Travelers | $82 | 86% |
| Wc Michigan Millers Mutual | $82 | 86% |
| Wc Society | $82 | 86% |
| Wc Cna | $82 | 86% |
| Wc Claims Mgmt Inc | $82 | 86% |
| Wc Massachusetts | $82 | 86% |
| Wc Comp One Admin C/O Manageability | $82 | 86% |
| Wc California State Comp Ins | $82 | 86% |
| East Greenbush Central School District | $82 | 86% |
| Wc Great West Casualty | $82 | 86% |
| Njm Insurance Group | $82 | 86% |
| Wc Nationwide | $82 | 86% |
| Wc Unified Health Services | $82 | 86% |
| Wc Meadowbrook Claim | $82 | 86% |
| Wc Align Network | $82 | 86% |
| Rx Worker's Comp | $82 | 86% |
| Wc Troy Ny | $82 | 86% |
| Wc Praxis Health Network | $82 | 86% |
| Wc Chartis | $82 | 86% |
| Wc Compone Admin | $82 | 86% |
| Wc Key Ins & Benefit Solutions | $82 | 86% |
| Wc Srs | $82 | 86% |
| Wc American Claims Mgmt | $82 | 86% |
| Wc Mitchell Frankenmuth | $82 | 86% |
| Wc Medical Administrators | $82 | 86% |
| Wc Mac Risk Management | $82 | 86% |
| Wc Broward County | $82 | 86% |
| Wc Amerisure | $82 | 86% |
| Wc Bunch & Associates | $82 | 86% |
| Wc Hastings | $82 | 86% |
| Wc Aig | $82 | 86% |
| Wc Intermountain | $82 | 86% |
| Wc New York | $82 | 86% |
| Genex Wc | $82 | 86% |
| Wc Sentry | $82 | 86% |
| Wc Icw Group | $82 | 86% |
| Wc Evolutions | $82 | 86% |
| Wc Procura Management | $82 | 86% |
| Wc Ford Motor | $82 | 86% |
| Wc Am Trust N America | $82 | 86% |
| Wc Zenith | $82 | 86% |
| Wc Price Chopper | $82 | 86% |
| Wc Yankee Trails | $82 | 86% |
| Wc Taconic Farms | $82 | 86% |
| Wc Ace | $82 | 86% |
| Wc Kemberton | $82 | 86% |
| Wc Intercare Insurance | $82 | 86% |
| Wc Saif Oregon | $82 | 86% |
| Wc Cirma | $82 | 86% |
| Wc Reny Company | $82 | 86% |
| Rx Restat | $82 | 86% |
| Wc Chubb | $82 | 86% |
| Wc Capitol Area Health Consortium | $82 | 86% |
| Wc Genex Care for Ohio | $82 | 86% |
| Wc Enablecomp | $82 | 86% |
| Wc York Risk | $82 | 86% |
| Wc Peerless | $82 | 86% |
| Wc Meijers | $82 | 86% |
| Wc Rural Mutual | $82 | 86% |
| Wc Advantage | $82 | 86% |
| Wc Benetech | $82 | 86% |
| Wc Generic | $82 | 86% |
| Wc Sedgwick | $82 | 86% |
| Wc Paradigm | $82 | 86% |
| Wc Us Dept of Labor | $82 | 86% |
| Wc Fcci | $82 | 86% |
| Wc Accident Fund | $82 | 86% |
| Wc Zurich | $82 | 86% |
| Wc Velocity | $82 | 86% |
| Wc Rev Claims | $82 | 86% |
| Wc Erie | $82 | 86% |
| Wc Guarantee Insurance | $82 | 86% |
| Wc Qualcare | $82 | 86% |
| Wc Secura | $82 | 86% |
| Wc United Heartland | $82 | 86% |
| Wc Federated | $82 | 86% |
| Wc Health Management | $82 | 86% |
| Wc Mercy Workcare | $82 | 86% |
| Wc Gallagher Bassett | $82 | 86% |
| Wc Guard Insurance Company | $82 | 86% |
| Wc Johns Eastern | $82 | 86% |
| Wc Ccmsi | $82 | 86% |
| Wc Hartford | $82 | 86% |
| Wc Ct Healthcare Trust | $82 | 86% |
| Rx Heatlhcomp | $82 | 86% |
| Wc Sheakley Unicomp | $82 | 86% |
| Wc Emc Insurance Company | $82 | 86% |
| Wc Donegal Insurance Group | $82 | 86% |
| Wc Employee Mutual | $82 | 86% |
| Wc Tristar | $82 | 86% |
| Wc Risico | $82 | 86% |
| Wc Fed Ex | $82 | 86% |
| Wc Taconic (Mro) | $82 | 86% |
| Wc Alaska National Ins | $82 | 86% |
| Wc New York Special Funds | $82 | 86% |
| Asrm - Reliance Standard Life Insurance | $115 - $119 | 121% |
| Trinity Health Share | $115 - $119 | 121% |
| Manhattan Life | $115 - $119 | 121% |
| Paramount HMO | $115 - $119 | 121% |
| Family Life Insurance Company | $115 - $119 | 121% |
| Allied National Global Care | $115 - $119 | 121% |
| Pan-American Life | $115 - $119 | 121% |
| Fallon Health | $115 - $119 | 121% |
| Devon Health Services | $115 - $119 | 121% |
| PHCS | $115 - $119 | 121% |
| International Benefit Administrators | $115 - $119 | 121% |
| Medi Share | $115 - $119 | 121% |
| Dean Health | $115 - $119 | 121% |
| Ghc Scw | $115 - $119 | 121% |
| Christian Care Ministry | $115 - $119 | 121% |
| Multiplan | $115 - $119 | 121% |
| Lifetime Benefit Solutions | $115 - $119 | 121% |
| Pai | $115 - $119 | 121% |
| Meritain | $118 | 124% |
| Coventry | $118 | 124% |
| Vitalcore | $122 - $126 | 128% |
| Three Rivers Provider Network | $128 - $133 | 134% |
| Prime Health Services | $128 - $133 | 134% |
| Galaxy Health Network | $128 - $133 | 134% |
| Wc Corvel | $128 - $133 | 134% |