CMS Price Transparency Data

Diagnostic procedure preparation

Facility: Southern Ocean Medical Center

Billing Code: G0279 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0279
Insurance Median: $81
Cash Discount Price: $54
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Diagnostic procedure preparation at Southern Ocean Medical Center is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.00x the Medicare baseline. Located in 1140 Rt 72 W, Manahawkin, NJ.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $54 (134%)

Insurance Median: $81 (200%)

Cash: $54 (134% of Medicare)

Ins. Median: $81 (200% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 200% of the Medicare baseline (a markup of 100%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerihealth	$20	49%
Karna	$35 - $83	87%
Clover	$37	92%
Aetna	$38 - $160	94%
Seoul Medical Group	$42	104%
UnitedHealthcare	$48 - $69	119%
Amerigroup	$54	134%
Vaccn	$54	134%
Wellcare	$54	134%
United Community/Americhoice	$57	141%
Oxford	$69 - $110	171%
Cigna	$95 - $163	235%
Horizon	$133 - $186	329%
Bergen Risk	$153	379%
Multiplan - PHCS	$173	428%
Brighton Health Plan	$184	455%
Qualcare	$185	458%

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 $54.
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 Southern Ocean 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.