CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Henry Ford Macomb Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $414
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Henry Ford Macomb Hospital is $414. 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 $1,222.56, this hospital’s rate is 0.34x the Medicare baseline. Located in 15855 Nineteen Mile Rd, Clinton Township, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$414

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Insurance Median: $414 (34%)

Ins. Median: $414 (34% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 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
Aetna	$109 - $2,740	9%
Blue Cross Blue Shield	$109 - $1,384	9%
Hap	$109 - $1,155	9%
Mclaren	$109	9%
Meridian Health Plan Of Mi	$109 - $1,560	9%
Priority Health	$109 - $1,784	9%
Amerihealth Michigan	$127 - $1,132	10%
Hap Caresource	$127 - $1,155	10%
Mclaren Health Plan Inc.	$127 - $422	10%
Meridian	$127 - $422	10%
Molina	$132 - $1,560	11%
Priority	$133 - $422	11%
Humana	$167 - $1,178	14%
Pace Se Mi	$193 - $401	16%
Bcn	$203 - $1,155	17%
Cca Health Mi	$203 - $422	17%
Health Alliance Plan Of Michigan	$203 - $422	17%
Mount Carmel Health Plan	$203 - $1,155	17%
United Behavioral Health, Inc.	$203 - $422	17%
UnitedHealthcare	$203 - $1,155	17%
Wellcare Ma	$203	17%
Wellcare	$205	17%
Vitalcore Physicians Group Of Mi	$264 - $2,657	22%
Cigna	$670 - $1,654	55%
Cofinity Group Health	$756 - $1,524	62%
Mclaren Health	$1,085 - $1,155	89%
Pace Of Se Mi	$1,097	90%
Cca Health Michigan	$1,155	94%
Molina Mi Health Link	$1,155	94%
Multiplan, Inc.	$1,360	111%
University Of Michigan	$1,648	135%

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: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Henry Ford Macomb Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
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.