CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: McLaren Macomb

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $499
Cash Discount Price: $1,224
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at McLaren Macomb is $499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,224. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.53x the Medicare baseline. Located in 1000 Harrington St, Mount Clemens, MI.

Cash / Self-Pay

$1,224

Average discount available for prompt cash payment at this facility.

Insurance Median

$499

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: $1,224 (129%)

Insurance Median: $499 (53%)

Cash: $1,224 (129% of Medicare)

Ins. Median: $499 (53% 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
Medicaid / KanCare	$117 - $524	12%
Humana	$163 - $889	17%
Medicare (plans)	$163 - $1,423	17%
Hap - Hmo	$179	19%
U Of M Health Plan	$187	20%
Aetna	$233	25%
Priority Health	$276	29%
Blue Cross Blue Shield	$292 - $924	31%
UnitedHealthcare	$325	34%
Mclaren Commercial Ins	$350	37%
Tricare	$804	85%
Mi Amish Medical Board	$889	94%

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 $1,224.
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 McLaren Macomb 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.