CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Caribou Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $383
Cash Discount Price: $974
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Caribou Medical Center is $383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $974. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.40x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$974

Average discount available for prompt cash payment at this facility.

Insurance Median

$383

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: $974 (103%)

Insurance Median: $383 (40%)

Cash: $974 (103% of Medicare)

Ins. Median: $383 (40% 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	$154	16%
Pacific Source Mcr Adv	$154	16%
Regence Blue Shield Mcr	$154	16%
Select Health Mcr Adv	$154	16%
Aetna	$158 - $545	17%
Blue Cross Blue Shield	$177 - $393	19%
Cigna	$262	28%
Select Health-All Other Plans	$309	33%
Montana Health Co-Op-All Plans	$374	39%
Select Health/Bright Path Mcr Adv	$391	41%
Bc Qualified Hp (Qhp)	$393	41%
Regence Blue Shield-All Other Plans	$456	48%
First Choice Health-All Plans	$1,252	132%
Pacific Source-All Other Plans	$1,349	142%
UnitedHealthcare	$1,363	143%

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 $974.
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 Caribou 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.