CMS Price Transparency Data

Diagnostic procedure preparation

Facility: Saint Michael's Medical Center

Billing Code: G0279 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0279
Insurance Median: $21
Cash Discount Price: $14
vs. Medicare Baseline: 0.52x Medicare

The contracted insurance negotiated median rate for a Diagnostic procedure preparation at Saint Michael's Medical Center is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.52x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$14

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $14 (35%)

Insurance Median: $21 (52%)

Cash: $14 (35% of Medicare)

Ins. Median: $21 (52% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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
Tricare	$12	30%
Aetna	$15 - $31	37%
Amerihealth	$15 - $16	37%
Clover Health	$15	37%
Curana	$15	37%
Horizon	$15 - $116	37%
Humana	$15	37%
Medicare (plans)	$15	37%
New Jersey Out of State	$15	37%
UnitedHealthcare	$15 - $38	37%
Wellcare	$15 - $20	37%
Wellpoint Amerigroup	$15	37%
Fairprice Healthcare Holdings - Fphh	$18	45%
Employer Direct Healthcare	$21	52%
Cigna	$23	57%
Naphcare	$23	57%
Coventry	$29	72%

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 $14.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0279.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Saint Michael's Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0279.
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.