CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Overlook Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,368
Cash Discount Price: $1,573
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Overlook Medical Center is $1,368. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,573. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.12x the Medicare baseline. Located in 99 Beauvoir Avenue, Summit, NJ.

Cash / Self-Pay

$1,573

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,368

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: $1,573 (129%)

Insurance Median: $1,368 (112%)

Cash: $1,573 (129% of Medicare)

Ins. Median: $1,368 (112% 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
Wtc Health Program [5273]	$397	32%
Aetna	$1,368 - $1,915	112%
Ambetter / Centene	$1,368	112%
Amerihealth Administrators Supplemental [5512]	$1,368	112%
Amerihealth Medigap [5049]	$1,368	112%
Blue Cross Blue Shield	$1,368	112%
Champva [5354]	$1,368	112%
Cigna	$1,368	112%
Claim Watcher/Homestead [5488]	$1,368	112%
Claimdoc [5434]	$1,368	112%
Cosmetic Surgery/Lap Band/Gastric Bypass [5289]	$1,368	112%
Fairos [5491]	$1,368	112%
Highmark Wholecare Health Plan Ip Splits [5464]	$1,368	112%
Highmark Wholecare Health Plan [5413]	$1,368	112%
Karen Ann Quinlan [5285]	$1,368	112%
Luminare Health AHS Retiree [5013]	$1,368	112%
Medicaid / KanCare	$1,368	112%
Medicare (plans)	$1,368 - $1,416	112%
Omc Pediatric Muscle Lengthening [5360]	$1,368	112%
Sedgwick Wtc Health Program Wc [5514]	$1,368	112%
Specialty Imaging [5433]	$1,368	112%
Tricare	$1,368	112%
UPMC [5455]	$1,368	112%
Us Family Health Plan [5258]	$1,368	112%
VA Community Care Network [5403]	$1,368	112%
Wellcare Behavioral Health [5335]	$1,368	112%
Wellcare Health Plans Ip Splits [5475]	$1,368	112%
Wellcare Health Plans [5269]	$1,368	112%
Amerihealth Caritas Vip Care Ip Splits [5460]	$1,382	113%
Amerihealth Caritas Vip Care [5313]	$1,382	113%
Kindred Giralda Hospital [5341]	$1,505	123%
Horizon Nj Health [5021]	$3,008	246%
Amerihealth [5008]	$5,253 - $6,049	430%
Kessler Foundation [5532]	$12,000	982%

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 $1,573.
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 Overlook 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.