CMS Price Transparency Data
Injection procedure for pain management
Facility: Newton Medical Center
Billing Code: G0260 (HCPCS)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: G0260
- Insurance Median: $1,497
- Cash Discount Price: $780
- vs. Medicare Baseline: 2.08x Medicare
The contracted insurance negotiated median rate for a Injection procedure for pain management at Newton Medical Center is $1,497. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $780. Compared to the federal Medicare reimbursement reference rate of $721.17, this hospital’s rate is 2.08x the Medicare baseline. Located in 175 High St, Newton, NJ.
Cash / Self-Pay
$780
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,497
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$721.17
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $721.17 (100%)
Cash / Self-Pay: $780 (108%)
Insurance Median: $1,497 (208%)
Cash: $780 (108% of Medicare)
Ins. Median: $1,497 (208% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $721.17 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 208% of the Medicare baseline (a markup of 108%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Wtc Health Program [5273] | $106 | 15% |
| Blue Cross Blue Shield | $201 - $11,952 | 28% |
| Medicaid / KanCare | $201 - $757 | 28% |
| Untd Hlth Community Plan Behavioral Health [5293] | $221 | 31% |
| Untd Hlth Community Plan [5034] | $221 | 31% |
| Aetna | $241 - $1,125 | 33% |
| Wellcare Behavioral Health [5335] | $757 - $804 | 105% |
| Ambetter / Centene | $757 - $804 | 105% |
| Luminare Health AHS Retiree [5013] | $757 - $804 | 105% |
| Claimdoc [5434] | $757 - $804 | 105% |
| Amerihealth Medigap [5049] | $757 - $804 | 105% |
| Karen Ann Quinlan [5285] | $757 | 105% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $757 - $804 | 105% |
| Cigna | $757 - $804 | 105% |
| Fairos [5491] | $757 | 105% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $757 | 105% |
| Medicare (plans) | $757 - $832 | 105% |
| Sedgwick Wtc Health Program Wc [5514] | $757 - $804 | 105% |
| VA Community Care Network [5403] | $757 - $804 | 105% |
| Amerihealth Administrators Supplemental [5512] | $757 - $804 | 105% |
| Us Family Health Plan [5258] | $757 - $804 | 105% |
| Tricare | $757 - $804 | 105% |
| Claim Watcher/Homestead [5488] | $757 - $1,497 | 105% |
| Wellcare Health Plans Ip Splits [5475] | $757 - $804 | 105% |
| Wellcare Health Plans [5269] | $757 - $804 | 105% |
| Highmark Wholecare Health Plan [5413] | $757 - $804 | 105% |
| Champva [5354] | $757 - $804 | 105% |
| Specialty Imaging [5433] | $757 | 105% |
| UPMC [5455] | $757 - $804 | 105% |
| Amerihealth Caritas Vip Care Ip Splits [5460] | $764 - $812 | 106% |
| Amerihealth Caritas Vip Care [5313] | $764 - $812 | 106% |
| Kindred Giralda Hospital [5341] | $832 - $884 | 115% |
| Medlogix/Consumer Health Network (Chn) [5415] | $1,497 - $2,545 | 208% |
| Magnacare [5177] | $1,497 - $2,246 | 208% |
| Praxis Workers Comp [5515] | $1,497 - $2,246 | 208% |
| First Managed Care Option [5109] | $1,497 - $2,545 | 208% |
| The Fairly Group [5528] | $1,497 | 208% |
| Inservco Workers Compensation [5158] | $1,497 - $2,545 | 208% |
| Occunet [5490] | $1,497 | 208% |
| Liberty Mutual Worker's Comp [5174] | $1,587 | 220% |
| Pma Workers Comp [5224] | $1,587 | 220% |
| Sentry Worker's Comp [5489] | $1,587 | 220% |
| Travelers Workers Compensation [5250] | $1,587 | 220% |
| Sedgwick [5235] | $1,587 | 220% |
| Gallagher Bassett Workers Comp [5117] | $1,587 | 220% |
| Kaiser Permanente [5162] | $1,647 | 228% |
| Ila Local 1478-2 Welfare Fund [5448] | $1,647 | 228% |
| Private Healthcare Systems PPO (PHCS) [5227] | $1,647 | 228% |
| Oscar [5213] | $1,647 | 228% |
| Continental Assurance - PHCS [5092] | $1,647 | 228% |
| Qualcare [5026] | $1,647 - $1,728 | 228% |
| Continental Casualty PHCS [5094] | $1,647 | 228% |
| Coresource [5014] | $1,647 | 228% |
| Humana | $1,647 | 228% |
| Ghi Emblem Health [5122] | $1,647 | 228% |
| Church Mutual Wc Insurance Company [5524] | $1,689 | 234% |
| Selective Ins Workers Comp [5237] | $1,689 | 234% |
| Hcs Network Solutions [5148] | $1,689 | 234% |
| Strategic Comp [5518] | $1,689 | 234% |
| Nj Manufacturers Workers Comp [5204] | $1,689 | 234% |
| Hartford Worker's Compensation [5132] | $1,689 | 234% |
| Zurich Workers Comp [5275] | $1,689 | 234% |
| Hanover Workers Comp [5130] | $1,689 | 234% |
| Geico No Fault [5120] | $1,787 | 248% |
| Hanover No Fault [5129] | $1,787 | 248% |
| Travelers No Fault [5249] | $1,787 | 248% |
| Zurich No Fault [5274] | $1,787 | 248% |
| Allstate [5047] | $1,787 | 248% |
| Liberty Mutual No Fault [5173] | $1,787 | 248% |
| State Farm No Fault [5241] | $1,787 | 248% |
| Progressive No Fault [5229] | $1,787 | 248% |
| Nj Manufacturers No Fault [5203] | $1,787 | 248% |
| Esurance No Fault [5105] | $1,787 | 248% |
| Usaa No Fault [5260] | $1,787 | 248% |
| Occunet Secondary [5517] | $1,796 | 249% |
| The Fairly Group Secondary [5531] | $1,796 | 249% |
| First Health Network [5108] | $1,946 | 270% |
| Independence Bc [5479] | $2,052 | 285% |
| Prime Healthcare [5435] | $2,052 | 285% |
| One Call Workers Comp [5418] | $2,096 | 291% |
| Multiplan [5194] | $2,096 | 291% |
| Qual-Lynx Wc Preferred [5230] | $2,246 | 311% |
| Amtrust North America Inc [5521] | $2,246 | 311% |
| Broadspire Workers Comp [5357] | $2,246 | 311% |
| Ccmsi Wc [5525] | $2,246 | 311% |
| Sage Adjusting, LLC [5527] | $2,246 | 311% |
| Qual-Lynx Wc Standard [5028] | $2,246 | 311% |
| Aig Workers Compensation [5045] | $2,246 | 311% |
| Berkshire Hathaway Guard Insurance Company [5529] | $2,246 | 311% |
| Nationwide Mutual Insurance Company [5526] | $2,246 | 311% |
| Plymouth Rock Assurance No Fault [5222] | $2,395 | 332% |
| High Point No Fault [5146] | $2,395 | 332% |
| Medlogix/Consumer Health Network Pip (Chn) [5414] | $2,395 | 332% |
| Chubb Worker's Compensation [5075] | $2,545 | 353% |
| Esis [5519] | $2,545 | 353% |
| Corvel Corporation [5522] | $2,545 | 353% |
| Medrisk/Spnet Worker's Comp [5452] | $2,545 | 353% |
| Claims Resolution Corporation Inc [5520] | $2,545 | 353% |
| Streamline Worker's Comp [5540] | $2,994 | 415% |
| Atlantic Home Care and Hospice [5055] | $2,994 | 415% |
| Carisk Worker's Comp [5501] | $2,994 | 415% |
| Carba R Generic [5530] | $2,994 | 415% |
| Bundled Cases/Episodic Payment [5492] | $2,994 | 415% |
| Horizon Nj Health [5021] | $3,167 | 439% |
| Amerihealth [5008] | $3,331 - $4,096 | 462% |
| Kessler Foundation [5532] | $12,000 | 1664% |