CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Highland Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $473
Cash Discount Price: $3,820
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Highland Hospital is $473. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,820. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.50x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$3,820

Average discount available for prompt cash payment at this facility.

Insurance Median

$473

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: $3,820 (402%)

Insurance Median: $473 (50%)

Cash: $3,820 (402% of Medicare)

Ins. Median: $473 (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
Medicaid / KanCare	$88 - $3,615	9%
Aetna	$145 - $1,403	15%
Excellus Bc/Bs [2201]	$145 - $938	15%
Medicare (plans)	$145 - $1,494	15%
UnitedHealthcare	$155 - $3,615	16%
Elderplan [1316]	$171 - $313	18%
Icircle [1728]	$171 - $313	18%
Martins Point [1205]	$171 - $1,161	18%
Nascentia [1729]	$171 - $313	18%
Humana	$172 - $1,381	18%
Fidelis [5155]	$206 - $3,615	22%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$225 - $1,444	24%
Highmark Bc/Bs Of Western Ny [5143]	$270 - $584	28%
Mvp [2900]	$312 - $3,042	33%
Independent Health [5156]	$323 - $693	34%
Cigna	$407 - $3,367	43%
Capital District Physicians Health Plan (Cdphp) [5149]	$446 - $1,116	47%
Amerigroup (Bswny Alternate) [1720]	$463 - $3,615	49%
Excellus [2201]	$463	49%
Blue Cross Blue Shield	$1,161 - $1,654	122%
Molina Healthcare [5189], Molina Healthcare [1723]	$1,185 - $3,615	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 $3,820.
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 Highland 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.