CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Charlevoix Area Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $598
Cash Discount Price: $642
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Charlevoix Area Hospital is $598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $642. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.63x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$642

Average discount available for prompt cash payment at this facility.

Insurance Median

$598

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: $642 (68%)

Insurance Median: $598 (63%)

Cash: $642 (68% of Medicare)

Ins. Median: $598 (63% 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
Blue Cross Blue Shield	$53 - $706	6%
Mclaren Health Plan	$59 - $711	6%
Meridian	$59 - $656	6%
Priority Health	$59 - $764	6%
UnitedHealthcare	$59 - $664	6%
Aetna	$81 - $690	9%
Blue Care Network	$81 - $359	9%
Hap (Health Alliance Plan)	$81 - $1,396	9%
Medicare (plans)	$81 - $359	9%
Michigan Amish Medical Board	$81 - $359	9%
Molina	$81 - $388	9%
Northern Michigan Mennonite Group	$81 - $359	9%
Asr Physicians Care Network	$122 - $611	13%
Nomi Health	$130 - $711	14%
Employee Benefits Logistics	$138 - $610	15%
Cigna	$333 - $764	35%
Hospice Of Michigan	$448 - $458	47%
Enterprise Group Planning Employee Benefit Plan	$598 - $611	63%
First Health/Coventry Health/Community Care Network	$598 - $611	63%
Medical Cost Savings Solution	$598 - $611	63%
Provider Network Of America/Hma Group Health	$635 - $1,303	67%
Three Rivers Provider Network	$635 - $649	67%
Iba Health And Life Assurance Company	$687 - $703	72%
Cofinity	$695 - $711	73%
Preferred Medical Claim Solutions	$710 - $726	75%

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 $642.
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 Charlevoix Area Hospital 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.