CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Joseph's University Medical Center Inc

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $164
  • Cash Discount Price: $570
  • vs. Medicare Baseline: 1.21x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Joseph's University Medical Center Inc is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $570. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.21x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$570

Average discount available for prompt cash payment at this facility.

Insurance Median
$164

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $570 (420%)
Insurance Median: $164 (121%)
Cash: $570 (420% of Medicare)
Ins. Median: $164 (121% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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 $69 - $158 51%
UnitedHealthcare $69 - $365 51%
Aetna $85 - $307 63%
Ambetter / Centene $91 - $226 67%
Amerihealth $91 - $363 67%
Clover Health $91 - $151 67%
Horizon New Jersey Total Care $91 - $151 67%
Wellpoint $91 - $151 67%
Blue Cross Blue Shield $115 - $429 85%
Oxford $117 - $365 86%
Amerihealth Behavioral Health $121 - $170 89%
Multiplan $137 - $428 101%
Consumer Health Network $155 - $513 114%
Longevity Health Plan $173 128%
Horizon New Jersey Health $177 - $308 131%
Private Healthcare Systems $235 - $370 173%
Cigna $362 - $570 267%
Magnacare $399 294%
Oscar $537 396%

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