CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: North Alabama Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,008
Cash Discount Price: $1,610
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at North Alabama Medical Center is $1,008. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,610. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.06x the Medicare baseline. Located in 1701 Veterans Drive, Florence, AL.

Cash / Self-Pay

$1,610

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,008

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: $1,610 (169%)

Insurance Median: $1,008 (106%)

Cash: $1,610 (169% of Medicare)

Ins. Median: $1,008 (106% 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
Key Benefit Administrators	$67	7%
Viva Health, Inc	$403 - $2,486	42%
UnitedHealthcare	$416 - $1,411	44%
Aetna	$424 - $2,585	45%
Humana	$437	46%
Healthcomp North	$515	54%
Blue Cross Blue Shield	$518 - $1,422	55%
Ambetter / Centene	$541	57%
Simpra Advantage	$765	81%
Veteran Family Member Program	$765	81%
Healthspring Markets	$835	88%
Government Employees Health Association	$838	88%
Performance Health	$1,064	112%
Cigna	$1,556 - $5,197	164%
Meritain Health	$2,508	264%
Nippon Life Benefits	$2,585	272%

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 $1,610.
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 North Alabama 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.