CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Sparrow Ionia Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $539
Cash Discount Price: $225
vs. Medicare Baseline: 0.57x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Sparrow Ionia Hospital is $539. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.57x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$539

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: $225 (24%)

Insurance Median: $539 (57%)

Cash: $225 (24% of Medicare)

Ins. Median: $539 (57% 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 - $1,045	12%
Aetna	$168 - $998	18%
Covenant Advantage	$168 - $225	18%
Medicare (plans)	$168 - $312	18%
Medigold	$168 - $225	18%
Senior Community Care	$168 - $225	18%
Humana	$177 - $728	19%
Blue Cross Blue Shield	$292 - $950	31%
Priority	$414 - $552	44%
UnitedHealthcare	$517 - $690	54%
Cigna	$534 - $712	56%
Great West Healthcare	$534 - $712	56%
Asr	$539 - $719	57%
Blue Care Network	$539 - $719	57%
Health Alliance Plan	$539 - $719	57%
Cofinity	$546 - $728	57%
Mclaren Commercial	$601 - $801	63%
Priority Health Medihmo	$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 $225.
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 Sparrow Ionia 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.