CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Catherine of Siena Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45378
  • Insurance Median: $1,079
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.14x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Catherine of Siena Hospital is $1,079. 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 1.14x the Medicare baseline. Located in 50 Route 25A, Smithtown, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,079

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: $1,079 (114%)
Ins. Median: $1,079 (114% 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.

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
Zadroga $389 41%
Affinity Health Plan $1,004 - $2,259 106%
Beacon Health Options $1,004 - $1,510 106%
Beacon Health Strategies $1,004 - $1,510 106%
Centerlight Healthcare $1,004 - $1,079 106%
Elderplan Inc. $1,004 - $1,079 106%
Emblem Health $1,004 - $3,902 106%
Fidelis Care New York $1,004 - $2,259 106%
Health First $1,004 - $2,427 106%
Health Plus $1,004 - $2,259 106%
Independent Health $1,004 - $1,079 106%
Medicaid / KanCare $1,004 106%
Mvp Health Plans $1,004 - $2,656 106%
Senior Whole Health $1,004 - $1,079 106%
UnitedHealthcare $1,004 - $3,612 106%
Blue Cross Blue Shield $1,057 - $3,488 111%
Aetna $1,079 - $4,197 114%
Centers Plan For Healthy Living $1,079 114%
Healthspring $1,079 114%
Liberty Health $1,079 114%
Longevity Health Plan $1,079 114%
Medicare (plans) $1,079 - $1,133 114%
Orthonet - Uniformed Services Family Health Plan $1,079 114%
Pmc $1,079 114%
Tricare $1,079 114%
Universal Healthcare $1,079 114%
Us Family Health Plan $1,079 114%
Veterans Affairs $1,079 114%
Humana $1,100 116%
Agewell New York $1,117 118%
Partners Health Plan $1,133 119%
Wellcare Health Plan Inc $1,187 125%
Brighton $1,200 - $3,547 126%
Apwu $2,656 280%
Centivo $2,656 - $3,398 280%
Cigna $2,656 280%
Daniel H Cook $2,656 280%
Nalc $2,656 280%
Samba $2,656 280%
Self Pay $3,488 367%
Surest $3,612 380%
American Plan Administrators $3,902 411%
Amerihealth Administrators $3,902 411%
Benefit Services $3,902 411%
Ghi Cbp Ny City Employee Alternate $3,902 411%
International Benefit Administrator $3,902 411%
Ultra Benefits Inc. $3,902 411%
Local 1199 $3,945 415%
Mail Handlers Benefit Plan $4,197 442%
Meritain Health $4,197 442%
Nippon Life Insurance Company Of America $4,197 442%
Salvation Army $4,197 442%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 50 Route 25A, Smithtown, NY 11787
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals