CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,726
Cash Discount Price: $1,078
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Saint Clare's Hospital/ Denville Campus is $1,726. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,078. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.82x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$1,078

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,726

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: $1,078 (113%)

Insurance Median: $1,726 (182%)

Cash: $1,078 (113% of Medicare)

Ins. Median: $1,726 (182% 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
Humana	$863	91%
Aetna	$1,078 - $2,286	113%
Amerihealth	$1,078	113%
Clover Health	$1,078	113%
Horizon	$1,078 - $2,242	113%
Medicare (plans)	$1,078	113%
Tricare	$1,078	113%
UnitedHealthcare	$1,078 - $4,390	113%
Wellcare	$1,078 - $1,456	113%
Wellpoint Amerigroup	$1,078	113%
Ally-Align (Fka Spartan Health Plan)	$1,132	119%
Employer Direct Healthcare	$1,510	159%
Cigna	$1,667	175%
Fairprice Healthcare Holdings - Fphh	$1,726	182%
Brighton Health Plan Solutions (Fka Magnacare)	$1,989	209%
Coventry	$2,157	227%

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 $1,078.
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 Saint Clare's Hospital/ Denville Campus 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.