CMS Price Transparency Data

Neurobehavioral status check

Facility: St Joseph's University Medical Center Inc

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $257
  • Cash Discount Price: $1,099
  • vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at St Joseph's University Medical Center Inc is $257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,099. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.17x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$1,099

Average discount available for prompt cash payment at this facility.

Insurance Median
$257

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$220.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $220.6 (100%)
Cash / Self-Pay: $1,099 (498%)
Insurance Median: $257 (117%)
Cash: $1,099 (498% of Medicare)
Ins. Median: $257 (117% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $220.6 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.

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 $58 - $269 26%
UnitedHealthcare $58 - $343 26%
Horizon New Jersey Health $65 - $267 29%
Aetna $77 - $550 35%
Ambetter / Centene $77 - $385 35%
Amerihealth $77 - $700 35%
Clover Health $77 - $257 35%
Horizon New Jersey Total Care $77 - $257 35%
Wellpoint $77 - $257 35%
Amerihealth Behavioral Health $100 45%
Blue Cross Blue Shield $100 - $958 45%
Consumer Health Network $111 - $989 50%
Multiplan $116 - $824 53%
Private Healthcare Systems $204 - $714 92%
Longevity Health Plan $295 134%
Cigna $314 - $1,099 142%
Oxford $316 143%
Magnacare $769 349%
Oscar $1,035 469%

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