CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adventist Health St Helena

Billing Code: 45380 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$806

about 0.7× the $1,223 Medicare rate · typically $325–$4,784

modeled estimate · not a bill or quote

What this hospital charges insurers

$264

Below the fair price — a good deal

about $542 under the fair price · 0.2× Medicare

Medicare pays $1,223 Fair price $806 This hospital $264 Cash price $111 Hospital's list price $740

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $165 Priciest $264

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $806 (about 0.7× the $1,223 Medicare rate). Adventist Health St Helena charges insurers about $264, or about $111 in cash — below the fair price — a good deal. Located in Saint Helena, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Kaiser Permanente Humana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$264	22%
Blue Cross Blue Shieldmajor	$193 - $833	16%
Aetnamajor	$383	31%
Cignamajor	$247	20%
Kaiser Permanentemajor	$193 - $232	16%
+ 3 smaller / regional plans	$213 - $629

Government programs also on file: Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 111), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Adventist Health St Helena is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Adventist Health St Helena

Compare: Colonoscopy with biopsy at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.