CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Forks Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,677
Cash Discount Price: $3,818
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Forks Community Hospital is $2,677. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,818. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.82x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$3,818

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,677

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: $3,818 (402%)

Insurance Median: $2,677 (282%)

Cash: $3,818 (402% of Medicare)

Ins. Median: $2,677 (282% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 282% of the Medicare baseline (a markup of 182%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicare (plans)	$318	33%
Medicaid / KanCare	$1,426 - $2,204	150%
Coordinated Care (Mco) Mcd-All Plans	$1,540 - $2,246	162%
UnitedHealthcare	$1,835 - $5,112	193%
Community Health Network Mcr-All Other Plans	$1,855 - $2,706	195%
Humana	$1,855 - $2,706	195%
Tricare	$1,855 - $2,706	195%
Triwest-All Plans	$1,855 - $2,706	195%
Ambetter / Centene	$2,152 - $3,139	227%
Wellcare Med Adv - All Plans	$2,152 - $3,139	227%
Regence-All Other Plans	$2,374 - $3,463	250%
Community Health Exchange	$2,680 - $3,909	282%
Molina Commercial-All Other Plans	$3,793 - $5,533	399%
Blue Cross Blue Shield	$3,917 - $5,713	412%
Aetna	$4,123 - $6,014	434%
Cigna	$4,123 - $6,014	434%
First Choice-All Plans	$4,123 - $6,014	434%

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 $3,818.
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 Forks Community 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.