CMS Price Transparency Data

Colonoscopy with biopsy

Facility: USA Health Children's & Women's Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $616
Cash Discount Price: $1,231
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at USA Health Children's & Women's Hospital is $616. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,231. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.50x the Medicare baseline. Located in 1700 Center Street, Mobile, AL.

Cash / Self-Pay

$1,231

Average discount available for prompt cash payment at this facility.

Insurance Median

$616

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $1,231 (101%)

Insurance Median: $616 (50%)

Cash: $1,231 (101% of Medicare)

Ins. Median: $616 (50% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 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	$470	38%
UnitedHealthcare	$477 - $874	39%
Aetna	$480 - $677	39%
Devoted Health	$480 - $862	39%
Humana	$480 - $800	39%
Viva Health	$480 - $616	39%
Wellcare	$480	39%
Molina Marketplace	$528	43%
Ambetter / Centene	$576	47%
Central Healthcare Services	$578 - $616	47%
Cigna	$586 - $800	48%
Mississippi Physicians Care Network (Mpcn)	$648	53%
Multiplan	$800 - $862	65%
Magnolia Health	$874	71%
Truecare	$874	71%
Molina Chip	$962	79%
Novanet	$1,108	91%

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 $1,231.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm USA Health Children's & Women's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
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.