CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $650
Cash Discount Price: $541
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Cincinnati Children's Hospital Medical Center is $650. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $541. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.68x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$541

Average discount available for prompt cash payment at this facility.

Insurance Median

$650

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: $541 (57%)

Insurance Median: $650 (68%)

Cash: $541 (57% of Medicare)

Ins. Median: $650 (68% 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	$83 - $1,061	9%
Caresource_Oh	$83 - $98	9%
Humana	$83 - $185	9%
Amerihealth_Caritas_Oh	$86 - $101	9%
Molina_Oh	$87 - $103	9%
Buckeye_Oh	$91 - $107	10%
United_Health_Care_Oh	$99 - $117	10%
Aetna	$132 - $1,061	14%
Wellcare_Ky	$139 - $185	15%
United_Health_Care_Ky	$140 - $186	15%
Passport_Ky	$184	19%
Caresource_In	$209 - $279	22%
Caresource_Oh_Insurance	$530	56%
Medical_Mutual_Of_Ohio_Insurance	$568 - $966	60%
Parkview_Signature_Care_Insurance	$650 - $765	68%
Point_Comfort_Insurance	$690	73%
Margaret_Mary_Health_Insurance	$703 - $828	74%
Cigna	$721 - $849	76%
Health_Ohio_Network_Insurance	$849 - $1,008	89%
Beechstreet_Insurance	$857 - $1,008	90%
Evolutions_Health_Care_Systems	$955	101%
Galaxy_Health_Insurance	$955	101%
Custom_Design_Benefits_Insurance	$1,008	106%
First_Health_Group_Insurance	$1,008	106%
Health_Link_Insurance	$1,008	106%
Health_Smart_Preferred_Insurance	$1,008	106%
Medical_Benefit_Administrators_Insurance	$1,008	106%
Ohio_Health_Choice_Insurance	$1,008	106%
Private_Health_Care_Systems_Insurance	$1,061	112%
United_Health_Care_Insurance	$1,061	112%

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 $541.
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 Cincinnati Children's Hospital Medical Center 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.