CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adventist Health Sonora

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $225
Cash Discount Price: $115
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Adventist Health Sonora is $225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.18x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $115 (9%)

Insurance Median: $225 (18%)

Cash: $115 (9% of Medicare)

Ins. Median: $225 (18% 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 Mcare	$178	15%
Central Ca Alliance Mcr Adv Profee Only	$178	15%
Healthnet Mcr Adv	$178	15%
Tricare	$178	15%
UnitedHealthcare	$178 - $583	15%
Ah Employee Health Plan - All Plans	$196	16%
Cigna	$219	18%
Greatwest Oa/Pos/Hmo	$231	19%
Greatwest Ppo - All Other Plans	$231	19%
Western Growers/Pinnacle - All Plans	$247	20%
Healthnet - All Other Plans	$259	21%
Aetna	$426	35%
Beech Street- All Plans	$609	50%
Trpn - Three Rivers Ppo - All Plans	$609	50%
Blue Shield Epn	$703	58%
Blue Shield - All Other Plans	$743	61%
Bc Mcs	$828	68%
Bc Non-Mcs - All Other Plans	$828	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 $115.
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 Sonora 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.