CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Adena Pike Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $4,292
Cash Discount Price: $2,848
vs. Medicare Baseline: 4.52x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Adena Pike Medical Center is $4,292. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,848. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 4.52x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$2,848

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,292

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: $2,848 (300%)

Insurance Median: $4,292 (452%)

Cash: $2,848 (300% of Medicare)

Ins. Median: $4,292 (452% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 452% of the Medicare baseline (a markup of 352%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$1,367 - $4,636	144%
Blue Cross Blue Shield	$1,367 - $4,915	144%
Buckeye Community Health Plan	$1,367	144%
Humana	$1,367 - $5,411	144%
Medical Mutual Of Ohio	$1,367 - $3,620	144%
Medigold	$1,367	144%
Molina	$1,367	144%
Care Source	$1,394	147%
Gateway Health	$1,880	198%
Molina Marketplace	$2,242	236%
Care Source Just4Me	$2,461	259%
UnitedHealthcare	$2,665	280%
Sidecar Health	$3,759	396%
Ohio Ppo Connect	$3,987	420%
The Health Plan	$3,987	420%
Cigna	$4,124	434%
Medical Mutual Of Ohio Supermed	$4,292	452%
First Health	$4,465	470%
Ohio Health Choice	$4,534	477%
Integrated Health Plan	$5,354	564%
Healthsmart	$5,411	570%
Multiplan/Private Healthcare Systems	$5,411	570%
Three Rivers Network	$5,411	570%

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 $2,848.
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 Adena Pike Medical Center 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.