CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Joseph's University Medical Center Inc

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45380
  • Insurance Median: $1,422
  • Cash Discount Price: $4,547
  • vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Joseph's University Medical Center Inc is $1,422. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,547. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.16x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$4,547

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,422

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: $4,547 (372%)
Insurance Median: $1,422 (116%)
Cash: $4,547 (372% of Medicare)
Ins. Median: $1,422 (116% 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.

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 $145 - $1,493 12%
UnitedHealthcare $145 - $3,425 12%
Aetna $194 - $6,397 16%
Ambetter / Centene $194 - $2,132 16%
Amerihealth $194 - $2,895 16%
Clover Health $194 - $1,422 16%
Horizon New Jersey Total Care $194 - $1,422 16%
Wellpoint $194 - $1,422 16%
Multiplan $290 - $3,410 24%
Consumer Health Network $507 - $4,092 41%
Blue Cross Blue Shield $544 - $4,048 44%
Private Healthcare Systems $914 - $2,956 75%
Horizon New Jersey Health $1,195 - $1,547 98%
Cigna $1,406 - $4,547 115%
Longevity Health Plan $1,635 134%
Oxford $3,155 258%
Magnacare $3,183 260%
Oscar $4,283 350%

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