CMS Price Transparency Data

Hepatitis C antibody test

Facility: St Joseph's University Medical Center Inc

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $30
  • Cash Discount Price: $245
  • vs. Medicare Baseline: 2.10x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at St Joseph's University Medical Center Inc is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $245. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.10x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$245

Average discount available for prompt cash payment at this facility.

Insurance Median
$30

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)
Cash / Self-Pay: $245 (1717%)
Insurance Median: $30 (210%)
Cash: $245 (1717% of Medicare)
Ins. Median: $30 (210% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14.27 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 210% of the Medicare baseline (a markup of 110%). 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
Aetna $14 - $50 98%
Amerihealth $14 - $156 98%
Blue Cross Blue Shield $14 - $214 98%
Clover Health $14 98%
Horizon New Jersey Total Care $14 98%
UnitedHealthcare $14 - $30 98%
Wellpoint $14 - $20 98%
Fidelis Care of New Jersey $15 - $49 105%
Longevity Health Plan $16 112%
Ambetter / Centene $21 147%
Consumer Health Network $21 - $220 147%
Oxford $30 210%
Horizon New Jersey Health $34 238%
Private Healthcare Systems $159 1114%
Magnacare $172 1205%
Multiplan $184 1289%
Oscar $231 1619%
Cigna $245 1717%

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