CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Univ. of Vermont - Fletcher Allen Health Care

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,162
Cash Discount Price: $4,293
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Univ. of Vermont - Fletcher Allen Health Care is $1,162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,293. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.22x the Medicare baseline. Located in 111 Colchester Ave, Burlington, VT.

Cash / Self-Pay

$4,293

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,162

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: $4,293 (452%)

Insurance Median: $1,162 (122%)

Cash: $4,293 (452% of Medicare)

Ins. Median: $1,162 (122% 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
Mvp	$145 - $3,220	15%
Aetna	$170 - $919	18%
Humana	$170 - $1,202	18%
St. Regis	$170 - $919	18%
Veterans Affairs Community Care Network	$170 - $919	18%
Blue Cross Blue Shield	$174 - $4,157	18%
Fidelis Care	$196 - $1,011	21%
UnitedHealthcare	$219 - $4,226	23%
Wellpath	$238 - $2,361	25%
Capital District Physicians' Health Plan	$320 - $3,215	34%
Martins Point	$320 - $942	34%
Ebpa	$1,085 - $3,692	114%
Harvard Pilgrim	$1,127 - $3,434	119%
Magnacare	$1,127 - $3,434	119%
Coventry	$1,198 - $3,649	126%
Cigna	$1,240 - $3,864	131%
Nppn	$1,268 - $3,864	133%

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 $4,293.
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 Univ. of Vermont - Fletcher Allen Health Care 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.