CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Ascension St Vincent's St Johns County

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $933
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Ascension St Vincent's St Johns County is $933. 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 0.98x the Medicare baseline. Located in 205 Trinity Way, St. Johns, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$933

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: $933 (98%)

Ins. Median: $933 (98% 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	$897 - $924	94%
Bc Advantage Mcr Replacement	$915	96%
Blue Cross Blue Shield	$915	96%
Community Hospice	$915	96%
Haven Hospice	$915	96%
Medicare (plans)	$915 - $933	96%
Pace Place	$915	96%
Research Study Encore Borland-Groover	$915	96%
Veterans Administration	$915	96%
Wellcare	$915	96%
Cigna	$924 - $933	97%
UnitedHealthcare	$924	97%
Careplus Mcr Replacement	$933	98%
Aetna	$943 - $11,236	99%
Smarthealth	$1,281	135%
Oscar Health Plan	$1,464	154%
Employer Direct Healthcare	$1,602	169%
90 Degree Benefits	$1,647	173%
Avmed Exchange	$1,647	173%
Molina Exchange	$1,693	178%
Occunet	$1,693 - $2,059	178%
Ambetter / Centene	$1,739	183%

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 Ascension St Vincent's St Johns County 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.