CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $897
Cash Discount Price: $3,676
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Memorial Hospital is $897. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,676. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.94x the Medicare baseline. Located in 500 London Avenue, Marysville, OH.

Cash / Self-Pay

$3,676

Average discount available for prompt cash payment at this facility.

Insurance Median

$897

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: $3,676 (387%)

Insurance Median: $897 (94%)

Cash: $3,676 (387% of Medicare)

Ins. Median: $897 (94% 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
Mount Carmel/Medigold	$852	90%
Aetna	$897 - $906	94%
Blue Cross Blue Shield	$897	94%
Caresource	$897	94%
Cigna	$897	94%
Core Care Select (Copc)	$897	94%
Humana	$897 - $915	94%
Molina	$897	94%
UnitedHealthcare	$897	94%
Medical Mutual Of Ohio	$906	95%
Buckeye Health Plan	$924	97%
Gateway Health Plan	$924	97%
Valor Health Plan	$924	97%
Caresource (Ohio Marketplace)	$1,417	149%
Accountable Health Plan Of Oh	$1,480	156%
Oscar	$1,524	160%

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 $3,676.
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 Memorial 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.