CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Anthony Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $4,188
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.41x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Anthony Community Hospital is $4,188. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 4.41x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,188

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%)

Insurance Median: $4,188 (441%)

Ins. Median: $4,188 (441% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 441% of the Medicare baseline (a markup of 341%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Hamaspik (McR)	$1,155	122%
World Trade Center Other	$1,155	122%
Medicare (plans)	$1,155 - $1,236	122%
Mvp Gold (McR)	$1,155	122%
World Trade Center Fdny	$1,155	122%
Affinity By Molina McR	$1,213	128%
Geisinger Health Commercial/Exchange	$3,812	401%
Blue Cross Blue Shield	$3,966 - $4,886	417%
Magnacare Preferred	$4,135	435%
Oxford Commercial	$4,143	436%
UnitedHealthcare	$4,188 - $4,927	441%
Oxford Exchange	$4,188	441%
Self-Pay	$5,500	579%
Cigna	$5,738	604%
Tricare	$6,220	655%
Aetna	$6,250 - $6,944	658%
Mvp Exchange	$6,508	685%
Mvp Hmo/Ppo	$14,367	1512%

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 $X.
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 St Anthony Community 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.