CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Valor Health

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,263
Cash Discount Price: $2,015
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Valor Health is $1,263. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,015. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.33x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$2,015

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,263

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: $2,015 (212%)

Insurance Median: $1,263 (133%)

Cash: $2,015 (212% of Medicare)

Ins. Median: $1,263 (133% 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
Aetna	$119 - $2,722	13%
Tricare	$146 - $1,486	15%
Blue Cross Blue Shield	$154 - $3,195	16%
Blue Shield Mcr Adv	$154 - $1,532	16%
Humana	$154 - $3,195	16%
Molina Mcr Adv - All Plans	$154 - $1,532	16%
Pacificsource Mcr Adv	$154 - $1,609	16%
Regence Bs Triwest - All Plans	$154 - $1,532	16%
Select Health Mcr Adv	$154	16%
UnitedHealthcare	$154 - $3,012	16%
Cigna	$293 - $3,009	31%
Moda Health - All Plans	$308 - $3,097	32%
Pacificsource Comm - All Other Plans	$356 - $3,097	37%
Select Health Comm - All Other Plans	$358 - $3,097	38%
Blue Shield Comm - All Other Plans	$363 - $3,097	38%

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 $2,015.
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 Valor Health 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.