CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Nationwide Children's Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $686
Cash Discount Price: $824
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Nationwide Children's Hospital is $686. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $824. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.72x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$824

Average discount available for prompt cash payment at this facility.

Insurance Median

$686

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: $824 (87%)

Insurance Median: $686 (72%)

Cash: $824 (87% of Medicare)

Ins. Median: $686 (72% 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
Amerihealth	$188 - $1,368	20%
Bchp	$188 - $1,368	20%
Blue Cross Blue Shield	$188 - $1,368	20%
Caresource	$188 - $1,425	20%
Humana	$188 - $1,368	20%
Molina	$188 - $1,368	20%
UnitedHealthcare	$188 - $1,368	20%
Tricare	$294 - $903	31%
Aetna	$612 - $686	64%
Mmo	$659	69%
Cigna	$686	72%
Front Path Health Coalition	$686	72%
Ohc	$686	72%
Ohg	$686	72%
Ohio Ppo Connect	$686	72%
Osu	$686	72%
The Health Plan	$686	72%

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 $824.
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 Nationwide Children's 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.