CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Claire Regional Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $509
Cash Discount Price: $1,568
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Claire Regional Medical Center is $509. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,568. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.54x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.

Cash / Self-Pay

$1,568

Average discount available for prompt cash payment at this facility.

Insurance Median

$509

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: $1,568 (165%)

Insurance Median: $509 (54%)

Cash: $1,568 (165% of Medicare)

Ins. Median: $509 (54% 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	$159 - $2,645	17%
Caresource Mcr Adv	$159 - $964	17%
Humana	$159 - $2,570	17%
Healthlink - All Plans	$168 - $2,545	18%
Aetna	$177 - $509	19%
Beacon Bh - All Plans	$185	19%
Wellcare Comm - All Other Plans	$198 - $3,121	21%
Ky Health Co-Op - All Plans	$206 - $4,774	22%
Caresource Just4Me - All Other Plans	$222 - $1,253	23%
Medicaid / KanCare	$509 - $1,031	54%
Wellcare Mcaid	$519 - $845	55%

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 $1,568.
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 Claire Regional 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.