CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Community Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,573

about 1.3× the $1,223 Medicare rate · typically $1,121–$2,523

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,677

Above the fair price

about $1,104 over the fair price · 2.2× Medicare

Medicare pays $1,223 Fair price $1,573 This hospital $2,677 Cash price $3,786

How we calculate the fair BaseRate →

How this hospital compares to other NJ hospitals

Highest price of the 9 NJ hospitals we have prices for — worth calling around.

Cheapest $849 Priciest $2,677

Black dot = this hospital, among the 9 NJ hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $1,573 (about 1.3× the $1,223 Medicare rate). Community Medical Center charges insurers about $2,677, or about $3,786 in cash — above the fair price. Located in Toms River, NJ.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $1,573. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,314 - $4,523	107%
Blue Cross Blue Shieldmajor	$340 - $3,266	28%
Aetnamajor	$1,289 - $5,009	105%
Cignamajor	$2,677 - $3,582	219%
Humanamajor	$1,289	105%
Clover Health	$1,289	105%
Fidelis Care	$1,289	105%
WellCare	$2,564	210%
+ 2 smaller / regional plans	$2,255 - $3,617

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,786), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Community Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Community Medical Center

Compare: Colonoscopy with biopsy at other NJ hospitals

St Joseph's University Medical Center Inc · Paterson $849
Newton Medical Center · Newton $1,288
AHS Hospital Corp · Hackettstown $1,288
Capital Health Regional Medical Center · Trenton $1,289
Centrastate Medical Center · Freehold $1,305
Jfk University Medical Center · Edison $1,306
Carewell Health Medical Center · East Orange $1,323
The University Hospital · Newark $1,345

Insurance negotiated median for the same procedure, sorted lowest first.