CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Robert Wood Johnson University Hospital - Somerset

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,564
Cash Discount Price: $6,311
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Robert Wood Johnson University Hospital - Somerset is $2,564. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,311. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.10x the Medicare baseline. Located in 110 Rehill Ave, Somerville, NJ.

Cash / Self-Pay

$6,311

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,564

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: $6,311 (516%)

Insurance Median: $2,564 (210%)

Cash: $6,311 (516% of Medicare)

Ins. Median: $2,564 (210% 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 210% of the Medicare baseline (a markup of 110%). 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
Wellpoint	$237 - $1,289	19%
Blue Cross Blue Shield	$302 - $1,289	25%
Aetna	$1,289 - $5,486	105%
Clover Health	$1,289	105%
Fidelis Care	$1,289	105%
Humana	$1,289	105%
UnitedHealthcare	$1,314 - $7,132	107%
Emblem Health	$2,255	184%
Wellcare	$2,564	210%
Cigna	$3,420 - $4,577	280%
Qualcare Inc	$9,057	741%

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 $6,311.
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 Robert Wood Johnson University Hospital - Somerset 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.