CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Mary's Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $177
Cash Discount Price: $335
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Mary's Hospital is $177. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $335. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.19x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$335

Average discount available for prompt cash payment at this facility.

Insurance Median

$177

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: $335 (35%)

Insurance Median: $177 (19%)

Cash: $335 (35% of Medicare)

Ins. Median: $177 (19% 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
Blue Cross Blue Shield	$142 - $260	15%
Nimiipuu Mcr Adv - Allplans	$154	16%
Regence Blue Shield Mcr	$154	16%
Tricare	$154	16%
UnitedHealthcare	$154 - $376	16%
Veterans Admin - All Plans	$154	16%
Medicare (plans)	$177	19%
Aetna	$246	26%
Corizon Correctional - All Plans	$338	36%
Idaho Phys Network - All Plans	$424	45%
Multiplan - All Plans	$428	45%
Geha - All Plans	$433	46%
First Choice- All Plans	$437	46%

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 $335.
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 St Mary's Hospital 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.