CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Mary's General Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,030
Cash Discount Price: $1,414
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Mary's General Hospital is $2,030. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,414. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.66x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$1,414

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,030

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $1,414 (116%)

Insurance Median: $2,030 (166%)

Cash: $1,414 (116% of Medicare)

Ins. Median: $2,030 (166% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 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
Humana	$1,132	93%
Aetna	$1,415 - $2,999	116%
Amerihealth	$1,415	116%
Clover Health	$1,415	116%
Horizon	$1,415 - $2,508	116%
Medicare (plans)	$1,415	116%
Tricare	$1,415	116%
UnitedHealthcare	$1,415 - $4,153	116%
Wellcare	$1,415 - $1,910	116%
Wellpoint Amerigroup	$1,415	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$1,485	121%
Employer Direct Healthcare	$1,981	162%
Cigna	$2,079	170%
Fairprice Healthcare Holdings	$2,263	185%
Coventry	$2,829	231%

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 $1,414.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Mary's General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
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.