CMS Price Transparency Data

CT scan, pelvis

Facility: St Joseph's University Medical Center Inc

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $150
Cash Discount Price: $2,397
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at St Joseph's University Medical Center Inc is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,397. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.40x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$2,397

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,397 (2244%)

Insurance Median: $150 (140%)

Cash: $2,397 (2244% of Medicare)

Ins. Median: $150 (140% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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	$41 - $480	38%
UnitedHealthcare	$41 - $426	38%
Aetna	$54 - $493	51%
Ambetter / Centene	$54 - $186	51%
Amerihealth	$54 - $1,526	51%
Clover Health	$54 - $150	51%
Horizon New Jersey Total Care	$54 - $150	51%
Wellpoint	$54 - $471	51%
Blue Cross Blue Shield	$59 - $450	55%
Multiplan	$81 - $1,798	76%
Private Healthcare Systems	$111 - $1,558	104%
Longevity Health Plan	$143	134%
Horizon New Jersey Health	$145 - $234	136%
Oxford	$160	150%
Cigna	$170 - $2,397	159%
Consumer Health Network	$386 - $2,157	361%
Magnacare	$1,678	1571%
Oscar	$2,258	2114%

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 $2,397.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.