CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Ascension Providence Hospital, Southfield and Novi

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $893
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Ascension Providence Hospital, Southfield and Novi is $893. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.94x the Medicare baseline. Located in 16001 W Nine Mile Rd, Southfield, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$893

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%)

Insurance Median: $893 (94%)

Ins. Median: $893 (94% 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
Molina Health	$396 - $518	42%
Hap Alliance Health	$460	48%
Hap Hmo Pos	$460	48%
Blue Caid Michigan	$518	55%
Harbor Health Mcd	$518	55%
Medicaid / KanCare	$518 - $893	55%
Total Health Care	$518	55%
UnitedHealthcare	$518	55%
Hap Preferred	$543	57%
Bc Metro Detroit Epo	$744 - $758	78%
Bc Metro Detroit Hmo	$744 - $758	78%
Bcn Local Network Southeast	$744 - $12,118	78%
Blue Care Network	$758 - $3,101	80%
Amerihealth Vip Care Mcr	$768 - $884	81%
Aetna	$893	94%
Auto Insurance	$893	94%
Jvhl - Mcr Replacement	$893	94%
Mcr Replacement	$893	94%
Veterans Choice	$893	94%
Humana	$902	95%
Meridian Wellcare	$938	99%
Molina Advantage	$938	99%
Ambetter / Centene	$1,117	118%
Molina Marketplace	$1,117	118%
Smart Health	$1,233	130%
Blue Cross Blue Shield	$3,101 - $12,118	326%

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 $X.
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 Ascension Providence Hospital, Southfield and Novi 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.