CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Duke University Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $780
Cash Discount Price: $1,084
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Duke University Hospital is $780. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,084. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.82x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$1,084

Average discount available for prompt cash payment at this facility.

Insurance Median

$780

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: $1,084 (114%)

Insurance Median: $780 (82%)

Cash: $1,084 (114% of Medicare)

Ins. Median: $780 (82% 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
Aetna	$83 - $2,964	9%
Amerihealth	$84 - $780	9%
Blue Cross Blue Shield	$84 - $1,569	9%
Carolina Complete Health	$84 - $780	9%
UnitedHealthcare	$84 - $5,003	9%
Humana	$86 - $2,641	9%
Piedmont Health	$157	17%
Troy Health	$157 - $888	17%
Voans	$157 - $888	17%
Cigna	$160 - $3,107	17%
Liberty	$160 - $906	17%
Alliance Health	$167 - $780	18%
Partners	$167 - $780	18%
Trillium	$167 - $780	18%
Sentara	$433 - $1,936	46%
Medcost	$1,324	139%

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 $1,084.
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 Duke University 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.