CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: University of Michigan Health - West

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $405
Cash Discount Price: $194
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at University of Michigan Health - West is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.43x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$194

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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: $194 (20%)

Insurance Median: $405 (43%)

Cash: $194 (20% of Medicare)

Ins. Median: $405 (43% 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	$114 - $509	12%
Priority Health	$213	22%
Web Tpa	$213	22%
Aetna	$325	34%
Alliance Health & Life Ppo	$325	34%
Asr Physicians	$325	34%
Hap	$325	34%
Golden Rule Ins	$350	37%
Medica	$350	37%
Student Ins/Mega Life	$350	37%
UnitedHealthcare	$350	37%
Humana	$364 - $950	38%
Asr Cofinity	$405	43%
Cofinity Commercial	$405	43%
Cofinity Weyco	$405	43%
Core Source	$405	43%
Epoch Group	$405	43%
Health Partners	$405	43%
Hlthcomp Admin	$405	43%
Mid America	$405	43%
Molina Healthcare Of Mi	$509	54%
Care Resources	$855	90%
Insight Metro Care	$950	100%
Medicare (plans)	$950	100%
Molina Marketplace Commercial	$950	100%

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 $194.
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 University of Michigan Health - West 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.