CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: St Joseph's University Medical Center Inc

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $21
Cash Discount Price: $405
vs. Medicare Baseline: 1.99x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at St Joseph's University Medical Center Inc is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $405. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.99x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$405

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $405 (3835%)

Insurance Median: $21 (199%)

Cash: $405 (3835% of Medicare)

Ins. Median: $21 (199% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 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
UnitedHealthcare	$10 - $22	95%
Aetna	$10 - $83	95%
Wellpoint	$11	104%
Clover Health	$11	104%
Fidelis Care of New Jersey	$11 - $81	104%
Amerihealth	$11 - $258	104%
Blue Cross Blue Shield	$11 - $353	104%
Horizon New Jersey Total Care	$11	104%
Longevity Health Plan	$12	114%
Ambetter / Centene	$16	152%
Oxford	$22	208%
Horizon New Jersey Health	$23	218%
Private Healthcare Systems	$263	2491%
Magnacare	$284	2689%
Multiplan	$304	2879%
Consumer Health Network	$364	3447%
Oscar	$382	3617%
Cigna	$405	3835%

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 $405.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Joseph's University Medical Center Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80053.
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.