CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Saint Michael's Medical Center

Billing Code: 45378 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,234

about 1.3× the $950 Medicare rate · typically $1,020–$2,330

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,672

Above the fair price

about $438 over the fair price · 1.8× Medicare

Medicare pays $950 Fair price $1,234 This hospital $1,672 Cash price $1,078 Hospital's list price $4,090

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 $248 Priciest $1,672

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

A fair price for a Colonoscopy (diagnostic) is about $1,234 (about 1.3× the $950 Medicare rate). Saint Michael's Medical Center charges insurers about $1,672, or about $1,078 in cash — above the fair price. Located in Newark, 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 $1,234. 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	$1,078 - $4,090	113%
Blue Cross Blue Shieldmajor	$1,078	113%
Aetnamajor	$1,078 - $2,286	113%
Cignamajor	$1,724	181%
Humanamajor	$1,078	113%
AmeriHealth	$1,078	113%
Clover Health	$1,122	118%
WellCare	$1,111 - $1,456	117%
+ 5 smaller / regional plans	$1,078 - $2,207

Government programs also on file: Medicare, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 1,078), 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: 45378.

Insurance Before you use insurance

Call your insurance company to confirm Saint Michael's Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
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 Saint Michael's Medical Center

Compare: Colonoscopy (diagnostic) at other NJ hospitals

St Joseph's University Medical Center Inc · Paterson $248
Newton Medical Center · Newton $996
Shore Medical Center · Somers Point $996
AHS Hospital Corp · Hackettstown $996
Centrastate Medical Center · Freehold $1,009
Jfk University Medical Center · Edison $1,010
Carewell Health Medical Center · East Orange $1,023
The University Hospital · Newark $1,040

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