CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Houlton Regional Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $640
Cash Discount Price: $1,192
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Houlton Regional Hospital is $640. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,192. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.67x the Medicare baseline. Located in 20 Hartford Street, Houlton, ME.

Cash / Self-Pay

$1,192

Average discount available for prompt cash payment at this facility.

Insurance Median

$640

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: $1,192 (125%)

Insurance Median: $640 (67%)

Cash: $1,192 (125% of Medicare)

Ins. Median: $640 (67% 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	$395 - $1,058	42%
Wellcare	$409	43%
Aetna	$413	43%
Tricare	$523	55%
Martins_Point	$640	67%
Community_Health	$1,104	116%
Cigna	$1,142	120%
United	$1,192	125%

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 $1,192.
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 Houlton Regional 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.