CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $483
Cash Discount Price: $2,723
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at The University of Vermont Health Network-Alice Hy is $483. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,723. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.51x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$2,723

Average discount available for prompt cash payment at this facility.

Insurance Median

$483

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: $2,723 (287%)

Insurance Median: $483 (51%)

Cash: $2,723 (287% of Medicare)

Ins. Median: $483 (51% 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
Fidelis Care	$145 - $976	15%
Humana	$145 - $976	15%
Mvp	$145 - $1,743	15%
Aetna	$171 - $2,622	18%
Veterans Affairs Community Care Network	$171 - $976	18%
Blue Cross Blue Shield	$181 - $2,950	19%
Capital District Physicians' Health Plan	$213 - $2,864	22%
UnitedHealthcare	$219 - $9,020	23%
Martins Point	$313 - $976	33%
Choicecare	$331 - $2,287	35%
St. Regis	$976 - $998	103%
Magnacare	$1,918 - $2,439	202%
Highmark Blueshield	$2,349 - $2,732	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 $2,723.
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-Alice Hy 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.