CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45378
  • Insurance Median: $163
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.17x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Munson Healthcare Otsego Memorial Hospital is $163. 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 0.17x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$163

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: $163 (17%)
Ins. Median: $163 (17% 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.

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
Blue Cross Blue Shield $53 - $485 6%
Mclaren Health Plan $59 - $485 6%
Meridian $59 - $485 6%
Molina $59 - $485 6%
Priority Health $59 - $1,019 6%
UnitedHealthcare $59 - $485 6%
Blue Care Network $81 - $163 9%
Hap (Health Alliance Plan) $81 - $244 9%
Humana $81 - $163 9%
Medicare (plans) $81 - $927 9%
Michigan Amish Medical Board $81 - $163 9%
Northern Michigan Mennonite Group $81 - $163 9%
Aetna $82 - $164 9%
Asr Physicians Care Network $122 - $244 13%
Nomi Health $130 - $260 14%
Employee Benefit Logistics $138 - $276 15%
Cigna $333 - $1,019 35%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 825 N Center Ave, Gaylord, MI 49735
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals