CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Joseph's University Medical Center Inc

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45378
  • Insurance Median: $696
  • Cash Discount Price: $4,281
  • vs. Medicare Baseline: 0.73x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Joseph's University Medical Center Inc is $696. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,281. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.73x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$4,281

Average discount available for prompt cash payment at this facility.

Insurance Median
$696

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: $4,281 (451%)
Insurance Median: $696 (73%)
Cash: $4,281 (451% of Medicare)
Ins. Median: $696 (73% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Fidelis Care of New Jersey $67 - $1,160 7%
UnitedHealthcare $67 - $3,425 7%
Aetna $90 - $6,397 9%
Ambetter / Centene $90 - $1,657 9%
Amerihealth $90 - $2,726 9%
Clover Health $90 - $1,105 9%
Horizon New Jersey Total Care $90 - $1,105 9%
Wellpoint $90 - $1,105 9%
Multiplan $135 - $3,211 14%
Blue Cross Blue Shield $160 - $3,146 17%
Consumer Health Network $450 - $3,853 47%
Private Healthcare Systems $707 - $2,783 74%
Horizon New Jersey Health $925 - $1,547 97%
Cigna $1,088 - $4,281 115%
Longevity Health Plan $1,271 134%
Magnacare $2,997 315%
Oxford $3,155 332%
Oscar $4,033 424%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals