CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Saint Francis Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,532
Cash Discount Price: $1,531
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Saint Francis Medical Center is $1,532. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,531. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.25x the Medicare baseline. Located in 3630 East Imperial Highway, Lynwood, CA.

Cash / Self-Pay

$1,531

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,532

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: $1,531 (125%)

Insurance Median: $1,532 (125%)

Cash: $1,531 (125% of Medicare)

Ins. Median: $1,532 (125% 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
Aids Healthcare Foundation	$474 - $1,562	39%
Avanti Hospitals, Llc	$474 - $1,532	39%
Health Net Of Ca	$474 - $1,991	39%
Heritage Provider Network	$474	39%
Kaiser Hospital Foundation	$474 - $1,532	39%
La Care Health Plan	$474 - $1,838	39%
Molina	$474 - $1,532	39%
Traditional Medi-Cal	$474	39%
Blue Shield Of Promise	$497 - $1,532	41%
Blue Cross Blue Shield	$521	43%
Alignment	$1,532	125%
Altamed	$1,532	125%
Blue Shield Of Ca, Va	$1,532	125%
Elite Health Plan	$1,532	125%
Medicare (plans)	$1,532	125%
Renal Payer Solutions	$1,532	125%
Tricare	$1,532	125%
UnitedHealthcare	$1,532	125%
Welbe Health Pace	$1,532	125%
Brand New Day	$1,547 - $2,297	127%
Imperial Health Plan Of Ca	$1,623	133%
Coventry Healthcare Wc, Inc.	$1,957	160%
Multiplan	$1,957	160%
Worker Comp	$2,018	165%
Aetna	$2,297	188%

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 $1,531.
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 Saint Francis Medical Center 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.