CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: The University of Vermont Health Network - Champl

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $737
Cash Discount Price: $2,792
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at The University of Vermont Health Network - Champl is $737. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,792. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.78x the Medicare baseline. Located in 75 Beekman Street, Plattsburgh, NY.

Cash / Self-Pay

$2,792

Average discount available for prompt cash payment at this facility.

Insurance Median

$737

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: $2,792 (294%)

Insurance Median: $737 (78%)

Cash: $2,792 (294% of Medicare)

Ins. Median: $737 (78% 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
Mvp	$145 - $3,451	15%
Aetna	$171 - $3,092	18%
Blue Cross Blue Shield	$171 - $5,290	18%
Fidelis Care	$171 - $1,114	18%
Humana	$171 - $1,058	18%
Veterans Affairs Community Care Network	$171 - $1,114	18%
UnitedHealthcare	$219 - $3,308	23%
Wellpath	$239 - $1,671	25%
Capital District Physicians' Health Plan	$313 - $3,418	33%
Martins Point	$313 - $1,193	33%
Highmark Blueshield	$503 - $3,295	53%
Harvard Pilgrim	$998 - $3,469	105%
Magnacare	$998 - $3,469	105%
St. Regis	$998 - $1,114	105%
Coventry	$1,122 - $3,902	118%
Multiplan	$1,185 - $4,119	125%
Emblem Health	$3,469	365%

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 $2,792.
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 The University of Vermont Health Network - Champl 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.