CMS Price Transparency Data

Culture, blood

Facility: St Joseph's University Medical Center Inc

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87040
  • Insurance Median: $21
  • Cash Discount Price: $232
  • vs. Medicare Baseline: 2.03x Medicare
The contracted insurance negotiated median rate for a Culture, blood 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 $232. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 2.03x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$232

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
$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)
Cash / Self-Pay: $232 (2248%)
Insurance Median: $21 (203%)
Cash: $232 (2248% of Medicare)
Ins. Median: $21 (203% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
UnitedHealthcare $9 - $21 87%
Wellpoint $9 - $10 87%
Aetna $10 - $48 97%
Amerihealth $10 - $148 97%
Blue Cross Blue Shield $10 - $202 97%
Clover Health $10 97%
Horizon New Jersey Total Care $10 97%
Fidelis Care of New Jersey $11 - $46 107%
Longevity Health Plan $12 116%
Horizon New Jersey Health $14 136%
Ambetter / Centene $15 145%
Oxford $21 203%
Consumer Health Network $24 - $209 233%
Private Healthcare Systems $151 1463%
Magnacare $162 1570%
Multiplan $174 1686%
Oscar $219 2122%
Cigna $232 2248%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals