CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Prisma Health Oconee Memorial Hospital
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $1,004
- Cash Discount Price: $2,299
- vs. Medicare Baseline: 1.06x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Prisma Health Oconee Memorial Hospital is $1,004. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,299. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.06x the Medicare baseline. Located in 298 Memorial Dr, Seneca, SC.
Cash / Self-Pay
$2,299
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,004
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: $2,299 (242%)
Insurance Median: $1,004 (106%)
Cash: $2,299 (242% of Medicare)
Ins. Median: $1,004 (106% 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 |
|---|---|---|
| Blue Cross Blue Shield | $305 - $1,924 | 32% |
| Bluechoice [810] | $364 - $2,599 | 38% |
| Medicaid / KanCare | $545 - $1,454 | 57% |
| UnitedHealthcare | $545 - $4,511 | 57% |
| Prisma Health Seniorcare Pace - Midlands [5400] | $821 | 86% |
| Prisma Health Seniorcare Pace-Upstate [5200] | $821 | 86% |
| Sc Dept Of Corrections [2998] | $833 | 88% |
| Scdc-Sc Dept Of Corrections [7232] | $833 | 88% |
| Tricare | $902 | 95% |
| Champva [3049] | $947 | 100% |
| Cigna | $947 - $2,455 | 100% |
| Covid19 Hrsa Uninsured Testing & Treatment Fund [904] | $947 | 100% |
| Deseret Mutual Ins Co [3066] | $947 | 100% |
| Generic Skilled Nursing [3196] | $947 | 100% |
| Hospice Contracted [1500] | $947 | 100% |
| Hospice Non Contracted [3190] | $947 | 100% |
| Medicare (plans) | $947 - $1,176 | 100% |
| Triwest Healthcare Alliance Vcp [902] | $947 | 100% |
| Va Community Care Network-Vaccn [903] | $947 | 100% |
| Veterans Administration [3194] | $947 | 100% |
| Humana | $966 - $1,258 | 102% |
| Aetna | $994 - $2,794 | 105% |
| Healthy Conn Prime-Wellcare Prime By Atc [5310] | $994 | 105% |
| Healthy Conn Prime-First Choice Vip Care [5300] | $1,004 | 106% |
| Bob Jones Univ-Pai [821] | $1,007 | 106% |
| Healthy Conn Prime-Molina Healthcare [5330] | $1,042 | 110% |
| First Choice Benefits Mgmt [3074] | $1,176 | 124% |
| Promise Health Plan Contracted [2401] | $1,238 - $2,122 | 130% |
| Workers Comp [600] | $1,326 | 140% |
| Orangeburg Senior Helping Center Pace [5401] | $1,415 | 149% |
| Ambetter / Centene | $1,742 | 183% |
| Planned Administrators [820] | $1,924 | 203% |
| Meritain Health Contracted [2200] | $2,264 - $2,794 | 238% |
| Evernorth Behavioral Contracted [2982] | $2,455 | 258% |
| Mvp Health Care [3037] | $2,455 | 258% |
| Preferred Administrators Contracted [2839] | $2,476 | 261% |
| Medcost [2940] | $2,617 - $2,936 | 275% |
| Atlantic Packaging Contracted [4833] | $2,653 | 279% |
| Aps Healthcare System [2981] | $2,830 | 298% |
| Multiplan/Phcs Contracted [2950] | $3,148 | 331% |
| Vsp Vision Care [2986] | $3,183 | 335% |
| First Health Contracted [2952] | $3,289 | 346% |
| Furman Int/Allen University Student [2951] | $3,289 | 346% |
| Quiktrip-First Health [3067] | $3,289 | 346% |
| Golden Rule Insurance Company [2991] | $4,511 | 475% |
| Oxford Health Plans [2992] | $4,511 | 475% |
| Zzumr-Salt Lake City Ut [3169] | $4,511 | 475% |