CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Southern Hills Hospital and Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,937
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Southern Hills Hospital and Medical Center is $1,937. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.04x the Medicare baseline. Located in 9300 West Sunset Rd, Las Vegas, NV.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,937

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%)

Insurance Median: $1,937 (204%)

Ins. Median: $1,937 (204% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Sierra Hpn	$205 - $333	22%
Community Care Health	$205 - $333	22%
Molina Healthcare	$205 - $346	22%
Caresource	$346	36%
United	$575 - $2,295	61%
Legacy Provider Network	$1,267	133%
Corvel	$1,338 - $1,520	141%
Olympus Medsave USA	$1,408 - $1,600	148%
Sierra	$1,583 - $1,795	167%
Aetna	$1,761 - $1,937	185%
Hometown Health Providers	$1,920 - $2,339	202%
Ambetter / Centene	$2,550	268%
Humana	$2,704	285%
Blue Cross Blue Shield	$2,860 - $3,720	301%
Multiplan	$3,500	368%
Select Health	$3,894 - $5,307	410%
Health Services Coalition	$4,260	448%
Cigna	$6,461	680%

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 $X.
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 Southern Hills Hospital and 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.