CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Holmes County Hospital and Clinics

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,218
Cash Discount Price: $640
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Holmes County Hospital and Clinics is $1,218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $640. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.28x the Medicare baseline. Located in 239 Bowling Green Road, Lexington, MS.

Cash / Self-Pay

$640

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,218

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: $640 (67%)

Insurance Median: $1,218 (128%)

Cash: $640 (67% of Medicare)

Ins. Median: $1,218 (128% 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
Advhealth-Lex	$507	53%
Ms-Can-Molina-Lex	$716	75%
Ms-Can-Magnolia-Lex	$723	76%
Ms-Can-Truecare-Lex	$729	77%
Cigna	$928	98%
Tricare	$982	103%
Humana	$998	105%
Mpcn-Lex	$1,040	109%
Medadv_Uhc-Lex	$1,088	115%
Firstchoice-Lex	$1,120	118%
Ambetter / Centene	$1,200	126%
Medadv_Primewell-Lex	$1,200	126%
Medicare (plans)	$1,200	126%
Primewell-Lex	$1,200	126%
Va_Ccn-Lex	$1,200	126%
Medadv_Uhcdsnp-Lex	$1,236	130%
Wellcare-Lex	$1,236	130%
Ppoplus	$1,248	131%
Devoted_Health-Lex	$1,260	133%
Firsthealth-Lex	$1,280	135%
Multiplan-Lex	$1,280	135%
Aetna	$1,360	143%
Phcs-Lex	$1,440	152%
Molina-Chip-Lex	$1,528	161%
Magnolia-Chip-Lex	$1,563	165%
Truecare-Chip-Lex	$1,563	165%
Blue Cross Blue Shield	$1,600	168%
Molina_Exchange-Lex	$1,600	168%
United-Lex	$1,600	168%
United-Options-Lex	$1,600	168%

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 $640.
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 Holmes County Hospital and Clinics 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.