CMS Price Transparency Data

Extended office visit (prolonged)

Facility: St Joseph's University Medical Center Inc

Billing Code: G2212 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G2212
Insurance Median: $37
Cash Discount Price: $101
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Extended office visit (prolonged) at St Joseph's University Medical Center Inc is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $34.07, this hospital’s rate is 1.09x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$34.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $34.07 (100%)

Cash / Self-Pay: $101 (296%)

Insurance Median: $37 (109%)

Cash: $101 (296% of Medicare)

Ins. Median: $37 (109% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $34.07 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
Fidelis Care of New Jersey	$22 - $39	65%
UnitedHealthcare	$22 - $37	65%
Blue Cross Blue Shield	$26 - $106	76%
Aetna	$30 - $76	88%
Ambetter / Centene	$30 - $56	88%
Amerihealth	$30 - $37	88%
Clover Health	$30 - $37	88%
Horizon New Jersey Total Care	$30 - $37	88%
Wellpoint	$30 - $37	88%
Longevity Health Plan	$43	126%
Multiplan	$44	129%
Private Healthcare Systems	$62 - $69	182%
Consumer Health Network	$72 - $79	211%
Horizon New Jersey Health	$82 - $90	241%
Cigna	$96 - $106	282%

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 $101.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G2212.

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 HCPCS code G2212.
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.