CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Adventist Health Castle

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $230
Cash Discount Price: $145
vs. Medicare Baseline: 0.24x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Adventist Health Castle is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.24x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $145 (15%)

Insurance Median: $230 (24%)

Cash: $145 (15% of Medicare)

Ins. Median: $230 (24% 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
Alohacare Quest Mcaid - All Other Plans	$165	17%
Kfh Mcr Adv	$165	17%
Medicare (plans)	$165	17%
UnitedHealthcare	$165	17%
Devoted Hlth Mcr Adv - All Plans	$170	18%
Alohacare Mcr Adv Profee Only	$173	18%
Hmsa Quest Abd	$193	20%
Multiplan Hmn - All Plans	$230	24%
Hwmg/Hmaa - All Plans	$320	34%
Hmsa Ppo - All Other Plans	$349	37%
Hmsa Hmo	$365	38%
State Of Hi Nonprofit - All Plans	$371	39%
First Health Ppo - All Plans	$426	45%
Mdx Hawaii Ppo - All Plans	$441	46%
Medicaid / KanCare	$453	48%
Ohana Health Plan - All Plans	$453	48%

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 $145.
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 Adventist Health Castle 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.