CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Carlsbad Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,310
Cash Discount Price: $1,385
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Carlsbad Medical Center is $1,310. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,385. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.38x the Medicare baseline. Located in 2430 West Pierce Street, Carlsbad, NM.

Cash / Self-Pay

$1,385

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,310

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: $1,385 (146%)

Insurance Median: $1,310 (138%)

Cash: $1,385 (146% of Medicare)

Ins. Median: $1,310 (138% 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
Veterans Eval Services	$311	33%
Blue Cross Blue Shield	$744 - $12,506	78%
Medicaid / KanCare	$744 - $837	78%
UnitedHealthcare	$820 - $9,170	86%
Department Of Veterans Affairs	$921	97%
Tricare	$921	97%
Medicare (plans)	$970	102%
Node Molina Mcr Adv	$970	102%
Presbyterian	$970 - $10,011	102%
Node Va	$986	104%
Triwest	$986	104%
Node Choice Care Mcr Adv	$1,019	107%
Node Devoted Health Mcr Adv	$1,019	107%
Us Department Of Labor	$1,232	130%
Wexford Health	$1,232	130%
Work Comp Nm	$1,235	130%
Self Pay	$1,385	146%
Node Molina Health Exchange	$2,692	283%
Nm Health Connection	$3,944	415%
Cigna	$6,926 - $11,608	729%
Eddy County Detention	$6,926	729%
Zelis	$8,727 - $11,636	919%
Omni Network	$9,004	948%
Capstar	$9,142	962%
Choice Care	$9,696	1021%
Ccn First Health	$11,082	1166%
Healthsmart	$11,220 - $11,913	1181%
Aetna	$11,636	1225%
Multiplan	$11,636	1225%
Medical Control Inc	$12,882	1356%

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 $1,385.
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 Carlsbad 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.