CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Westfield Memorial Hospital Inc

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $290
Cash Discount Price: $113
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Westfield Memorial Hospital Inc is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.31x the Medicare baseline. Located in 189 E Main St, Westfield, NY.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $113 (12%)

Insurance Median: $290 (31%)

Cash: $113 (12% of Medicare)

Ins. Median: $290 (31% 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
Univera	$74 - $265	8%
Highmark	$80 - $1,789	8%
Life Pittsburgh	$86 - $1,079	9%
Medicare (plans)	$91 - $1,111	10%
American Health Plans	$94 - $1,079	10%
Amerihealth	$190 - $1,133	20%
Pennsylvania Health And Wellness	$238 - $664	25%
Geisinger	$262 - $709	28%
UnitedHealthcare	$262 - $1,165	28%
Jefferson Health Plans	$276 - $678	29%
Cigna	$290	31%
Martin'S Point	$1,079	114%
Aetna	$1,122 - $2,071	118%
Humana	$1,144	120%
Molina	$1,176	124%

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 $113.
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 Westfield Memorial Hospital Inc 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.