CMS Price Transparency Data

Drug screening test

Facility: St Mary's General Hospital

Billing Code: G0480 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0480
Insurance Median: $82
Cash Discount Price: $114
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Drug screening test at St Mary's General Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $114.43, this hospital’s rate is 0.72x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$114.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $114.43 (100%)

Cash / Self-Pay: $114 (100%)

Insurance Median: $82 (72%)

Cash: $114 (100% of Medicare)

Ins. Median: $82 (72% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $114.43 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Horizon	$31 - $627	27%
Aetna	$44 - $243	38%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$44 - $120	38%
Amerihealth	$44 - $114	38%
Cigna	$44 - $166	38%
Clover Health	$44 - $114	38%
Coventry	$44 - $229	38%
Employer Direct Healthcare	$44 - $160	38%
Fairprice Healthcare Holdings	$44 - $137	38%
Humana	$44 - $92	38%
Medicare (plans)	$44 - $114	38%
Tricare	$44 - $114	38%
UnitedHealthcare	$44 - $114	38%
Wellcare	$44 - $154	38%
Wellpoint Amerigroup	$44 - $114	38%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $114.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0480.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Mary's General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0480.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.