CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $457
Cash Discount Price: $1,984
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Cleveland Clinic Indian River Hospital is $457. 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 0.48x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$1,984

Average discount available for prompt cash payment at this facility.

Insurance Median

$457

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: $457 (48%)

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

Ins. Median: $457 (48% 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
Avmed	$188 - $2,096	20%
Blue Cross Blue Shield	$188 - $4,076	20%
Careplus	$188 - $915	20%
Magellan	$188 - $2,822	20%
United	$188 - $2,728	20%
Value Options	$188 - $259	20%
Wellcare	$188 - $915	20%
Freedom Health	$197 - $915	21%
Independent Living Systems	$197 - $961	21%
Wellmed	$197 - $915	21%
Clear Spring Health	$203 - $247	21%
Aetna	$225 - $4,061	24%
UnitedHealthcare	$246	26%
Amerihealth	$259	27%
Medicaid / KanCare	$259	27%
Molina	$259	27%
Cigna	$273 - $1,411	29%
Clarity Health	$911 - $3,057	96%
The Legacy Companies	$911 - $3,057	96%
Carelon Bh Strategies	$915	96%
Humana	$915	96%
National Provider Network	$981	103%
Three Rivers	$981	103%
Devoted Health	$1,007	106%
Consociate Health	$1,052	111%
Bmi	$2,587	272%
Multiplan	$3,762	396%

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 Indian River 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.