CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Columbia Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $349
Cash Discount Price: $491
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Columbia Memorial Hospital is $349. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $491. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.37x the Medicare baseline. Located in 71 Prospect Avenue, Hudson, NY.

Cash / Self-Pay

$491

Average discount available for prompt cash payment at this facility.

Insurance Median

$349

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: $491 (52%)

Insurance Median: $349 (37%)

Cash: $491 (52% of Medicare)

Ins. Median: $349 (37% 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
UnitedHealthcare	$77 - $2,815	8%
Medicaid / KanCare	$103 - $928	11%
Mvp	$134 - $1,948	14%
Cdphp	$137 - $3,816	14%
Medicare (plans)	$144 - $358	15%
Blue Cross Blue Shield	$163 - $2,614	17%
Tricare	$163 - $358	17%
Hamaspik	$180 - $1,262	19%
Fidelis	$182 - $2,087	19%
Aetna	$198 - $3,094	21%
Blue Shield Highmark	$207 - $503	22%
Cigna	$250 - $456	26%
Emblem	$254 - $736	27%
Emblem Health Ghi	$263 - $491	28%
Magnacare	$756	80%
Multiplan	$884	93%
Herrington Diversified Pdh	$982	103%
Blue Shield	$1,568 - $2,814	165%
Empire Plan Nyship	$2,614	275%
Mvp Commercial	$8,795	926%

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 $491.
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 Columbia Memorial 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.