CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Calais Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $849
Cash Discount Price: $2,009
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Calais Community Hospital is $849. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,009. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.89x the Medicare baseline. Located in 24 Hospital Lane, Calais, ME.

Cash / Self-Pay

$2,009

Average discount available for prompt cash payment at this facility.

Insurance Median

$849

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: $2,009 (211%)

Insurance Median: $849 (89%)

Cash: $2,009 (211% of Medicare)

Ins. Median: $849 (89% 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	$172 - $3,590	18%
UnitedHealthcare	$172 - $3,889	18%
Humana	$367 - $1,990	39%
Wellcare	$367 - $1,990	39%
Partners Direct Health	$484 - $2,623	51%
Cigna	$701 - $3,803	74%
Aetna	$717 - $3,889	75%
Martins Point	$751 - $4,070	79%
Harvard Pilgrim	$763 - $4,138	80%

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 $2,009.
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 Calais Community 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.