CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Perham Health

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $471
Cash Discount Price: $857
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Perham Health is $471. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $857. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.50x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$857

Average discount available for prompt cash payment at this facility.

Insurance Median

$471

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: $857 (90%)

Insurance Median: $471 (50%)

Cash: $857 (90% of Medicare)

Ins. Median: $471 (50% 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
Ucare Mn Special Needs Basic Care Dual	$117 - $471	12%
Ucare Mn Medical Assistance	$129 - $475	14%
Ucare Mn Minnesota Care	$129 - $475	14%
Ucare Mn Senior Care Plus	$129 - $475	14%
Ucare Mn Special Needs Basic Care	$129 - $475	14%
Blue Cross Blue Shield	$156 - $2,742	16%
Health Partners Mcr Adv	$156 - $448	16%
Humana	$156 - $448	16%
Medicare (plans)	$156 - $528	16%
Medica Mcr Adv	$180 - $448	19%
Ucare Individual And Family Plan-All Other Plans	$188 - $660	20%
UnitedHealthcare	$199 - $1,319	21%
Ucare Mn Senior Health Options	$448 - $660	47%
Medicaid / KanCare	$476 - $1,359	50%
Medica Mcaid Mn Care	$483	51%
Medica Mn (Msho)	$543	57%
Sanford Health Plan-All Plans	$585 - $1,121	62%
Health Partners Minnesota Care	$660	69%
Medica Mn Senior Hp/Outside Mn	$673	71%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$725 - $989	76%
Medica Commercial-All Other Plans	$966	102%
Health Partners-All Plans	$1,082	114%
Preferred One (Ppo)	$1,121	118%

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 $857.
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 Perham 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.