CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Copley Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $461
Cash Discount Price: $858
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Copley Hospital is $461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $858. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.49x the Medicare baseline. Located in 528 Washington Highway, Morrisville, VT.

Cash / Self-Pay

$858

Average discount available for prompt cash payment at this facility.

Insurance Median

$461

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: $858 (90%)

Insurance Median: $461 (49%)

Cash: $858 (90% of Medicare)

Ins. Median: $461 (49% 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
Cigna	$312 - $1,018	33%
Harvard Pilgrim	$320 - $943	34%
Medicare (plans)	$320 - $461	34%
UnitedHealthcare	$320 - $1,018	34%
Blue Cross Blue Shield	$367 - $2,441	39%
Mvp	$461 - $836	49%

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 $858.
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 Copley 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.