CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Cleveland Clinic Martin North Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $385
Cash Discount Price: $1,984
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Cleveland Clinic Martin North Hospital is $385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,984. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.41x the Medicare baseline. Located in 200 Se Hospital Ave, Stuart, FL.

Cash / Self-Pay

$1,984

Average discount available for prompt cash payment at this facility.

Insurance Median

$385

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: $1,984 (209%)

Insurance Median: $385 (41%)

Cash: $1,984 (209% of Medicare)

Ins. Median: $385 (41% 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
Blue Cross Blue Shield	$172 - $6,861	18%
Avmed	$188 - $3,523	20%
Miami Childrens Health Plan	$188 - $915	20%
United	$188 - $3,287	20%
Careplus	$197 - $961	21%
Freedom Health	$197 - $961	21%
Independent Living Systems	$197 - $310	21%
Clear Spring Health	$203 - $249	21%
Aetna	$233 - $6,603	25%
Multiplan	$240 - $282	25%
Amerihealth	$266	28%
Molina	$272	29%
Sunshine Health	$272	29%
Cigna	$273 - $2,366	29%
Clarity Health	$911 - $3,057	96%
The Legacy Companies	$911 - $3,057	96%
Humana	$915	96%
Wellcare	$915	96%
Devoted Health	$1,007	106%
Consociate Health	$1,052	111%
Bmi	$2,587	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 $1,984.
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 Cleveland Clinic Martin North 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.