CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Raritan Bay Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,308
Cash Discount Price: $1,306
vs. Medicare Baseline: 2.71x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Raritan Bay Medical Center is $3,308. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,306. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.71x the Medicare baseline. Located in 530 New Brunswick Ave, Perth Amboy, NJ.

Cash / Self-Pay

$1,306

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,308

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: $1,306 (107%)

Insurance Median: $3,308 (271%)

Cash: $1,306 (107% of Medicare)

Ins. Median: $3,308 (271% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 271% of the Medicare baseline (a markup of 171%). 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
Karna	$419	34%
Aetna	$571 - $8,419	47%
Clover	$773	63%
Seoul Medical Group	$889	73%
UnitedHealthcare	$1,189 - $7,579	97%
Vaccn	$1,306	107%
Wellcare	$1,306	107%
Blue Cross Blue Shield	$1,306	107%
United Community/Americhoice	$1,372	112%
Amerigroup	$1,398	114%
Horizon	$2,438 - $6,602	199%
Amerihealth	$2,669 - $2,983	218%
Cigna	$2,981 - $3,435	244%
Bergen Risk	$3,220	263%
Multiplan - PHCS	$3,650	299%
Activecare First McO	$3,710	303%
Qualcare	$3,779 - $5,366	309%
Oxford	$6,058	496%
Brighton Health Plan	$9,933	812%

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 $1,306.
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 Raritan Bay Medical Center 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.