CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Capital Health Regional Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,856
Cash Discount Price: $31,686
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Capital Health Regional Medical Center is $2,856. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,686. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 3.01x the Medicare baseline. Located in 750 Brunswick Ave, Trenton, NJ.

Cash / Self-Pay

$31,686

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,856

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: $31,686 (3335%)

Insurance Median: $2,856 (301%)

Cash: $31,686 (3335% of Medicare)

Ins. Median: $2,856 (301% 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 301% of the Medicare baseline (a markup of 201%). 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 Nj Health	$168	18%
Fidelis	$996	105%
Medicare (plans)	$1,026	108%
Clover	$1,046	110%
Wellpoint	$1,046 - $1,369	110%
Humana	$1,067	112%
UnitedHealthcare	$1,267 - $6,150	133%
Medicaid / KanCare	$1,353	142%
Aetna	$1,711 - $7,684	180%
Oxford Benefit Plan	$4,000	421%
Cigna	$8,428 - $23,764	887%
Multiplan	$26,933	2835%
Blue Cross Blue Shield	$31,686	3335%

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 $31,686.
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 Capital Health Regional 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.