CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Larkin Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $480
Cash Discount Price: $463
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Larkin Community Hospital is $480. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $463. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.51x the Medicare baseline. Located in 7031 Sw 62Nd Ave, South Miami, FL.

Cash / Self-Pay

$463

Average discount available for prompt cash payment at this facility.

Insurance Median

$480

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: $463 (49%)

Insurance Median: $480 (51%)

Cash: $463 (49% of Medicare)

Ins. Median: $480 (51% 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
Medicare (plans)	$140 - $200	15%
Aetna	$200 - $738	21%
Fci-All Plans	$200	21%
Global Excel-All Plans	$200	21%
Clear Springs Hlth-All Plans	$210	22%
Fdc-All Plans	$230	24%
UnitedHealthcare	$250	26%
Jipa Network-All Plans	$380 - $480	40%
Medicaid / KanCare	$409 - $738	43%
Avmed-All Plans	$584 - $738	61%
Bright Health-All Other Plans	$584 - $738	61%
Coventry Comml-All Plans	$584 - $738	61%

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 $463.
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 Larkin 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.