CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Valley Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,080
Cash Discount Price: $3,233
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Valley Medical Center is $1,080. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,233. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.14x the Medicare baseline. Located in 400 S 43Rd St, Renton, WA.

Cash / Self-Pay

$3,233

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,080

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: $3,233 (340%)

Insurance Median: $1,080 (114%)

Cash: $3,233 (340% of Medicare)

Ins. Median: $1,080 (114% 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
Aetna	$91 - $3,295	10%
Humana	$91 - $1,102	10%
Great West [190102]	$385	41%
Christian Brother Employee Benefit Trust [110100]	$457	48%
Pacificsource [130122]	$457	48%
Soundpath Health-Termed [210113]	$820	86%
Blue Cross Blue Shield	$871 - $3,065	92%
Regence Blue Shield [170100]	$871	92%
Regence Uniform [130111]	$871	92%
Chpw Med Advantage [210102]	$1,080	114%
Medicare (plans)	$1,080 - $1,134	114%
Regence Medadvantage [210111]	$1,080	114%
UnitedHealthcare	$1,080 - $3,615	114%
Wellpoint Medadvantage [210115]	$1,080	114%
Chpw [130116]	$1,728	182%
Molina [130117]	$1,836	193%
Cigna	$3,061	322%
Kaiser Washington Contracted [130118]	$3,839	404%

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 $3,233.
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 Valley 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.