CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Joseph's University Medical Center Inc

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $124
  • Cash Discount Price: $767
  • vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Joseph's University Medical Center Inc is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $767. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.16x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$767

Average discount available for prompt cash payment at this facility.

Insurance Median
$124

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: $767 (718%)
Insurance Median: $124 (116%)
Cash: $767 (718% of Medicare)
Ins. Median: $124 (116% 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.

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 $26 - $286 24%
UnitedHealthcare $26 - $917 24%
Aetna $35 - $716 33%
Ambetter / Centene $35 - $186 33%
Amerihealth $35 - $911 33%
Clover Health $35 - $124 33%
Horizon New Jersey Total Care $35 - $124 33%
Wellpoint $35 - $281 33%
Blue Cross Blue Shield $38 - $354 36%
Multiplan $53 - $1,073 50%
Private Healthcare Systems $67 - $930 63%
Horizon New Jersey Health $87 - $444 81%
Cigna $103 - $1,431 96%
Longevity Health Plan $143 134%
Consumer Health Network $153 - $1,288 143%
Oxford $160 - $917 150%
Magnacare $1,002 938%
Oscar $1,348 1262%

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