CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Englewood Hospital and Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,074
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Englewood Hospital and Medical Center is $1,074. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.13x the Medicare baseline. Located in 350 Engle St, Englewood, NJ.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,074

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%)

Insurance Median: $1,074 (113%)

Ins. Median: $1,074 (113% 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.

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 New Jersey Health_674	$265	28%
Hip Health Plan	$966 - $1,020	102%
Heathnet Federal Services	$988	104%
Aetna	$1,074 - $1,772	113%
Americhoice_732	$1,074	113%
Amerigroup_758	$1,074	113%
Amerihealth_766	$1,074	113%
Blue Cross Blue Shield	$1,074	113%
Clover_733	$1,074	113%
Horizon New Jersey Health - Dsnp	$1,074	113%
Humana	$1,074	113%
UnitedHealthcare	$1,074 - $4,954	113%
Emblem_734	$1,110	117%
Wellcare_765	$1,160	122%
Health Care Support_787	$1,879	198%
Amerihealth_760	$1,932	203%
Magnacare_769	$3,978	419%
Oxford_741	$4,865	512%
Cigna	$5,713	601%

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 $X.
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 Englewood Hospital and Medical Center 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.