CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Southwestern Vermont Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $258
Cash Discount Price: $649
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Southwestern Vermont Medical Center is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $649. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.27x the Medicare baseline. Located in 100 Hospital Drive, Bennington, VT.

Cash / Self-Pay

$649

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $649 (68%)

Insurance Median: $258 (27%)

Cash: $649 (68% of Medicare)

Ins. Median: $258 (27% 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
UnitedHealthcare	$102 - $443	11%
Cdphp	$114 - $453	12%
Mvp	$127 - $461	13%
Bmc	$145 - $263	15%
Hne	$145 - $317	15%
Aetna	$167 - $554	18%
Blue Cross Blue Shield	$167 - $545	18%
Cigna	$167 - $522	18%
Fidelis	$167 - $332	18%
Humana	$167 - $317	18%
Wellcare	$167 - $317	18%
Health New England	$197 - $374	21%
Allegiance	$234 - $443	25%
Tufts	$282 - $503	30%
Harvard Pilgrim	$300 - $536	32%

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 $649.
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 Southwestern Vermont 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.