CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Southeast Health Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $858
Cash Discount Price: $987
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Southeast Health Medical Center is $858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $987. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.90x the Medicare baseline. Located in 1108 Ross Clark Circle, Dothan, AL.

Cash / Self-Pay

$987

Average discount available for prompt cash payment at this facility.

Insurance Median

$858

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: $987 (104%)

Insurance Median: $858 (90%)

Cash: $987 (104% of Medicare)

Ins. Median: $858 (90% 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	$446 - $892	47%
Blue Cross Blue Shield	$446 - $892	47%
Care Improvement Plus	$446 - $892	47%
Cigna	$446 - $892	47%
Humana	$446 - $892	47%
Security Health	$446 - $892	47%
Simpra Advantage	$446 - $892	47%
UnitedHealthcare	$446 - $1,848	47%
Viva Health	$446 - $892	47%
Wellcare	$446 - $892	47%
Ambetter / Centene	$602 - $1,204	63%
Direct Connect Contracting	$624 - $1,248	66%
Naphcare	$825 - $1,649	87%

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 $987.
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 Southeast Health 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.