CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Dekalb Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $861
Cash Discount Price: $1,261
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Dekalb Community Hospital is $861. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,261. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.91x the Medicare baseline. Located in 520 W Main St, Smithville, TN.

Cash / Self-Pay

$1,261

Average discount available for prompt cash payment at this facility.

Insurance Median

$861

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: $1,261 (133%)

Insurance Median: $861 (91%)

Cash: $1,261 (133% of Medicare)

Ins. Median: $861 (91% 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
Community Plan	$395	42%
Point Comfort Underwriters	$774	81%
Amerigroup Mcr Replacement	$861	91%
Ascension Complete	$861	91%
Blue Cross Blue Shield	$861 - $904	91%
Centurion Of Tn	$861	91%
Covid Uninsured Test Fund	$861	91%
Healthspring Mcr Replacement	$861	91%
Humana	$861	91%
Medicare (plans)	$861	91%
Nhc Advantage	$861	91%
UnitedHealthcare	$861	91%
Aetna	$878	92%
Ambetter / Centene	$1,119	118%
Cigna	$1,185 - $2,984	125%
Oscar Health	$1,205	127%
Smart Health	$1,205	127%

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 $1,261.
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 Dekalb Community Hospital 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.