CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adventist Health St Helena

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $264
Cash Discount Price: $111
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Adventist Health St Helena is $264. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.22x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$264

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: $111 (9%)

Insurance Median: $264 (22%)

Cash: $111 (9% of Medicare)

Ins. Median: $264 (22% 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 Shield Bh Mcr Adv	$193	16%
Blue Shield Mcr Adv	$193	16%
Kaiser Mcr Adv	$193	16%
Tricare	$193	16%
Ah Employee Health Plan - All Plans	$213	17%
Interplan-All Plans	$232	19%
Kaiser-All Other Plans	$232	19%
Cigna	$247	20%
UnitedHealthcare	$264	22%
Western Growers-All Plans	$276	23%
Aetna	$383	31%
Phcs-All Plans	$407	33%
Health Management Network-All Plans	$629	51%
Three Rivers-All Plans	$666	54%
Blue Shield Epn-All Other Plans	$789	65%
Blue Cross Blue Shield	$790	65%
Blue Shield Non-Epn	$833	68%

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 $111.
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 Adventist Health St Helena 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.