CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Astria Toppenish Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,020
Cash Discount Price: $1,335
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Astria Toppenish Hospital is $1,020. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,335. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.07x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$1,335

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,020

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: $1,335 (141%)

Insurance Median: $1,020 (107%)

Cash: $1,335 (141% of Medicare)

Ins. Median: $1,020 (107% 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
Medicaid / KanCare	$168 - $3,367	18%
Premera_Affordable_Care	$414 - $1,135	44%
Chpw_Cascade_Care	$692 - $1,896	73%
First_Choice	$758 - $2,077	80%
Li	$843	89%
Tpsc	$857 - $2,348	90%
Ambetter / Centene	$875	92%
UnitedHealthcare	$875 - $2,486	92%
Va	$875 - $1,035	92%
Molina	$892	94%
Medicare (plans)	$901 - $2,486	95%
Aetna	$932 - $2,649	98%
Cigna	$932	98%
Humana	$932 - $3,010	98%
Tricare	$932	98%
Zenith	$942	99%
Regence	$1,020	107%
Bcchp	$1,099 - $3,010	116%
Great_Rivers	$1,099 - $3,010	116%
Healthcomp	$1,099 - $3,010	116%
Washington_State_Hca	$1,099 - $3,010	116%
Premera	$1,135	119%
Molina_Exchange	$1,137	120%
Kaiser	$3,224	339%

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 $1,335.
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 Astria Toppenish 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.