CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Saratoga Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $313
Cash Discount Price: $1,302
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Saratoga Hospital is $313. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,302. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.33x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$1,302

Average discount available for prompt cash payment at this facility.

Insurance Median

$313

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: $1,302 (137%)

Insurance Median: $313 (33%)

Cash: $1,302 (137% of Medicare)

Ins. Median: $313 (33% 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
Aetna	$94 - $3,020	10%
Medicaid / KanCare	$103 - $315	11%
Cdphp	$116 - $4,172	12%
Fidelis	$128 - $2,093	13%
Medicare (plans)	$128 - $313	13%
Blue Cross Blue Shield	$141 - $3,449	15%
Tricare	$145 - $313	15%
Hamaspik	$159 - $2,186	17%
Mvp	$167 - $553	18%
Emblem Health Ghi	$171 - $345	18%
UnitedHealthcare	$171 - $2,343	18%
Blue Shield Highmark	$188 - $519	20%
Nascentia Health Options	$247	26%
Emblem	$254 - $1,510	27%
Cigna	$260 - $553	27%
Mvp Essential Plan	$930 - $1,860	98%
Mvp Govt Programs	$930	98%
Blue Shield	$1,744 - $4,443	184%
Empire Plan Nyship	$1,822 - $3,449	192%
Mvp Commercial	$1,822 - $4,445	192%
Multiplan	$1,952 - $2,213	205%
Magnacare	$2,343 - $2,473	247%

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 $1,302.
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 Saratoga 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.