CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Joseph's University Medical Center Inc

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $109
  • Cash Discount Price: $246
  • vs. Medicare Baseline: 1.15x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Joseph's University Medical Center Inc is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $246. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.15x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$246

Average discount available for prompt cash payment at this facility.

Insurance Median
$109

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $246 (258%)
Insurance Median: $109 (115%)
Cash: $246 (258% of Medicare)
Ins. Median: $109 (115% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 $47 - $111 49%
UnitedHealthcare $47 - $311 49%
Private Healthcare Systems $58 - $316 61%
Aetna $62 - $243 65%
Ambetter / Centene $62 - $159 65%
Amerihealth $62 - $309 65%
Clover Health $62 - $106 65%
Horizon New Jersey Total Care $62 - $106 65%
Wellpoint $62 - $106 65%
Horizon New Jersey Health $76 - $209 80%
Blue Cross Blue Shield $78 - $302 82%
Oxford $81 - $311 85%
Amerihealth Behavioral Health $82 - $116 86%
Cigna $90 - $486 95%
Multiplan $93 - $364 98%
Consumer Health Network $106 - $437 111%
Longevity Health Plan $122 128%
Magnacare $340 357%
Oscar $458 481%

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