CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Northside Hospital

Billing Code: 45378 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,012

about 1.1× the $950 Medicare rate · typically $492–$2,431

modeled estimate · not a bill or quote

What this hospital charges insurers

$547

Below the fair price — a good deal

about $465 under the fair price · 0.6× Medicare

Medicare pays $950 Fair price $1,012 This hospital $547 Cash price $414 Hospital's list price $552

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

A typical price — 1 charge more and 5 charge less, among the 9 GA hospitals compared.

Cheapest $200 Priciest $643

Black dot = this hospital, among the 9 GA hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy (diagnostic) is about $1,012 (about 1.1× the $950 Medicare rate). Northside Hospital charges insurers about $547, or about $414 in cash — below the fair price — a good deal. Located in Atlanta, GA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$168 - $6,943	18%
Blue Cross Blue Shieldmajor	$168 - $34,850	18%
Aetnamajor	$168 - $30,000	18%
Cignamajor	$174 - $8,162	18%
Humanamajor	$168 - $4,150	18%
Kaiser Permanentemajor	$168 - $4,110	18%
Ambetter (Centene)	$291 - $10,234	31%
Amerigroup	$291 - $9,085	31%
CareSource	$168 - $18,600	18%
Clover Health	$177 - $4,190	19%
Health Net	$314 - $7,875	33%
Oscar Health	$227 - $5,940	24%
WellCare	$168 - $4,110	18%
+ 16 smaller / regional plans	$177 - $50,000

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 7 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 414), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45378.

Insurance Before you use insurance

Call your insurance company to confirm Northside Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Northside Hospital

Compare: Colonoscopy (diagnostic) at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.