CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: OHSU Hospital and Clinics

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,054
Cash Discount Price: $2,284
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at OHSU Hospital and Clinics is $1,054. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,284. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.11x the Medicare baseline. Located in 3181 Sw Sam Jackson Park Road, Portland, OR.

Cash / Self-Pay

$2,284

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,054

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: $2,284 (240%)

Insurance Median: $1,054 (111%)

Cash: $2,284 (240% of Medicare)

Ins. Median: $1,054 (111% 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
Care Oregon	$418 - $1,232	44%
Intercommunity Health Network	$418 - $835	44%
Kaiser Foundation Hospitals	$418 - $2,428	44%
Medicare (plans)	$418 - $1,671	44%
Pacific Source	$418 - $2,734	44%
Humana	$522 - $1,107	55%
Trillium	$522 - $1,044	55%
Moda	$548 - $3,514	58%
UnitedHealthcare	$553 - $3,514	58%
Aetna	$564 - $2,741	59%
Health Net Health Plan Of Oregon, Inc.	$600 - $2,722	63%
Providence Health Plan	$627 - $3,514	66%
Community Health Plan Of Washington	$675 - $1,462	71%
Tuality Health	$940 - $1,880	99%
Samaritan Health Plan	$1,305 - $2,611	137%
Blue Cross Blue Shield	$1,420 - $2,840	149%
Cigna	$1,606 - $3,212	169%
Coventry First Health	$2,636	277%
First Choice	$2,663	280%
Molina Exchange	$3,514	370%

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 $2,284.
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 OHSU Hospital and Clinics 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.