CMS Price Transparency Data

Psychological testing by technician

Facility: St Joseph's University Medical Center Inc

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $399
Cash Discount Price: $798
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at St Joseph's University Medical Center Inc is $399. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $798. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 0.87x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$798

Average discount available for prompt cash payment at this facility.

Insurance Median

$399

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$456.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $456.4 (100%)

Cash / Self-Pay: $798 (175%)

Insurance Median: $399 (87%)

Cash: $798 (175% of Medicare)

Ins. Median: $399 (87% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $456.4 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	$33 - $557	7%
UnitedHealthcare	$33 - $531	7%
Blue Cross Blue Shield	$41 - $1,511	9%
Aetna	$44 - $1,083	10%
Ambetter / Centene	$44 - $796	10%
Amerihealth	$44 - $531	10%
Clover Health	$44 - $531	10%
Horizon New Jersey Total Care	$44 - $531	10%
Wellpoint	$44 - $531	10%
Amerihealth Behavioral Health	$46	10%
Multiplan	$66 - $598	14%
Private Healthcare Systems	$89 - $519	20%
Consumer Health Network	$103 - $718	23%
Horizon New Jersey Health	$117 - $247	26%
Cigna	$138 - $798	30%
Oxford	$511	112%
Magnacare	$559	122%
Longevity Health Plan	$610	134%
Oscar	$752	165%

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 $798.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96138.

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 CPT code 96138.
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.