CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Cleveland Clinic Avon Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,518
Cash Discount Price: $2,445
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Cleveland Clinic Avon Hospital is $1,518. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,445. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.60x the Medicare baseline. Located in 33300 Cleveland Clinic Blvd, Avon, OH.

Cash / Self-Pay

$2,445

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,518

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: $2,445 (257%)

Insurance Median: $1,518 (160%)

Cash: $2,445 (257% of Medicare)

Ins. Median: $1,518 (160% 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	$752 - $2,948	79%
Buckeye	$752	79%
Molina	$752	79%
Caresource	$766	81%
United	$766 - $4,338	81%
Aetna	$845 - $3,762	89%
Devoted Health	$845	89%
Humana	$845	89%
Mmo	$845 - $2,345	89%
Summacare	$845 - $1,512	89%
The Health Plan	$845 - $2,257	89%
UnitedHealthcare	$845 - $2,332	89%
Upmc	$845 - $2,257	89%
Valor	$845	89%
Cigna	$871 - $1,960	92%
Communicare	$887	93%
Perennial Health	$913	96%
Pphp	$930	98%
Zing Health	$930	98%
Oscar	$1,133 - $1,446	119%
Cc Ehp	$1,501 - $1,524	158%
Aultcare	$1,618	170%
Amish Community Aid Plan	$1,693 - $1,881	178%
Ohcp	$1,828	192%
Omas	$1,881	198%
Ohio Healthy	$2,031	214%
Php	$2,257	238%
Gms	$2,633	277%
Medical Benefit Corp	$2,633	277%
Consociate Health	$2,822	297%
Managed Care Services	$3,010	317%
Frontpath	$3,386	356%
Multiplan	$3,386	356%
Tertiary Care Network	$3,386	356%

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 $2,445.
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 Cleveland Clinic Avon 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.