CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: The University Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,083
Cash Discount Price: $1,196
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at The University Hospital is $2,083. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,196. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.19x the Medicare baseline. Located in 150 Bergen St, Newark, NJ.

Cash / Self-Pay

$1,196

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,083

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $1,196 (126%)

Insurance Median: $2,083 (219%)

Cash: $1,196 (126% of Medicare)

Ins. Median: $2,083 (219% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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 219% of the Medicare baseline (a markup of 119%). 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
Horizon	$434 - $2,083	46%
Amerihealth	$550 - $1,040	58%
Aetna	$876 - $1,697	92%
Fidelis	$876 - $1,040	92%
UnitedHealthcare	$876 - $1,040	92%
Wellpoint	$894	94%
Clover Health	$1,040	109%
First Health	$2,089	220%
Americare	$2,238	236%
Qualcare	$2,238	236%
Correctional Medical Services	$2,388	251%
Multiplan	$2,388	251%
United	$2,568	270%
First Trenton	$2,686	283%
Managed Care Inc	$2,686	283%
Consumer Health Network	$2,835	298%
Three Rivers	$2,835	298%

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 $1,196.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The University Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.