CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Jfk University Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,965
Cash Discount Price: $961
vs. Medicare Baseline: 3.12x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Jfk University Medical Center is $2,965. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $961. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 3.12x the Medicare baseline. Located in 65 James Street, Edison, NJ.

Cash / Self-Pay

$961

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,965

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: $961 (101%)

Insurance Median: $2,965 (312%)

Cash: $961 (101% of Medicare)

Ins. Median: $2,965 (312% 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 312% of the Medicare baseline (a markup of 212%). 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
Karna	$193 - $385	20%
Horizon	$332 - $8,615	35%
Aetna	$682 - $10,692	72%
UnitedHealthcare	$728 - $8,385	77%
Clover	$762	80%
Seoul Medical Group	$911	96%
Amerigroup	$912 - $1,010	96%
Vaccn	$912 - $1,010	96%
Wellcare	$912 - $1,010	96%
United Community/Americhoice	$957 - $1,061	101%
Blue Cross Blue Shield	$1,010	106%
Activecare First McO	$2,964	312%
Intergroup	$2,964	312%
Bergen Risk	$3,176	334%
Prime Health	$3,388	357%
Multiplan - PHCS	$3,600	379%
Cigna	$3,832	403%
Qualcare	$3,922	413%
Amerihealth	$4,006	422%
Oxford	$6,730	708%
Brighton Health Plan	$10,163	1070%

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 $961.
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 Jfk University 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.