CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Antelope Valley Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,593
Cash Discount Price: $4,047
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Antelope Valley Hospital is $1,593. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,047. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.30x the Medicare baseline. Located in 1600 W Ave J, Lancaster, CA.

Cash / Self-Pay

$4,047

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,593

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: $4,047 (331%)

Insurance Median: $1,593 (130%)

Cash: $4,047 (331% of Medicare)

Ins. Median: $1,593 (130% 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 Of California	$550	45%
Kaiser Foundation Hospitals	$1,081	88%
Alignment Healthcare	$1,532	125%
Central Health Plan Of California	$1,532	125%
Citizens Choice Healthplan	$1,532	125%
Health Net Of California	$1,532 - $2,144	125%
L.A. Care Health Plan	$1,532	125%
Wellcare	$1,532	125%
Humana	$1,562	128%
For Your Benefit	$1,577	129%
Brand New Day	$1,608	132%
Aids Foundation	$1,761	144%
Align Senior Care Ca	$1,761	144%
Champion Health Plan	$1,761	144%
Blue Shield	$1,788 - $5,286	146%
Clever Care Health Plan	$1,838	150%
Ca State Prison	$1,991	163%
Oscar Hp/Providence Health Network	$2,297	188%
Aetna	$3,767	308%

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 $4,047.
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 Antelope Valley 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.