CMS Price Transparency Data

Colonoscopy with biopsy

Facility: The University Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,195
Cash Discount Price: $1,547
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at The University Hospital is $2,195. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,547. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.80x the Medicare baseline. Located in 150 Bergen St, Newark, NJ.

Cash / Self-Pay

$1,547

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,195

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: $1,547 (127%)

Insurance Median: $2,195 (180%)

Cash: $1,547 (127% of Medicare)

Ins. Median: $2,195 (180% 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
Horizon	$523 - $2,694	43%
Amerihealth	$550 - $1,345	45%
Aetna	$876 - $2,195	72%
Fidelis	$876 - $1,345	72%
UnitedHealthcare	$876 - $1,345	72%
Wellpoint	$894	73%
Clover Health	$1,345	110%
First Health	$2,089	171%
Americare	$2,238	183%
Qualcare	$2,238	183%
Correctional Medical Services	$2,388	195%
Multiplan	$2,388	195%
United	$2,568	210%
First Trenton	$2,686	220%
Managed Care Inc	$2,686	220%
Consumer Health Network	$2,835	232%
Three Rivers	$2,835	232%

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 $1,547.
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 The University Hospital 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.