CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Marinhealth Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $4,011
Cash Discount Price: $7,023
vs. Medicare Baseline: 3.28x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Marinhealth Medical Center is $4,011. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,023. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.28x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

$7,023

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,011

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: $7,023 (574%)

Insurance Median: $4,011 (328%)

Cash: $7,023 (574% of Medicare)

Ins. Median: $4,011 (328% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 328% of the Medicare baseline (a markup of 228%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$844 - $8,796	69%
Brown And Tolan	$844 - $1,689	69%
Healthnet Tailored Network	$844 - $1,689	69%
Kaiser	$844 - $1,689	69%
Marin Cancer Care	$844 - $1,689	69%
Canopy Hill Physicians	$1,056 - $9,712	86%
Healthnet Hmo/Ppo Hill Physicians	$1,056 - $11,266	86%
Hills Blue Shield Hmo/Ppo	$1,056 - $11,130	86%
Ca Prison Health Care Services	$1,351 - $2,702	111%
Healthnet Enhancedcare	$2,196 - $4,391	180%
UnitedHealthcare	$2,330	191%
Provider Network Of America	$4,011 - $8,023	328%
Canopy	$4,856 - $9,712	397%
Blue Shield Cpic/Epo	$5,009 - $10,017	410%
Providers Network Of America	$5,320 - $10,641	435%
Blue Shield Hmo/Ppo	$5,565 - $11,130	455%
Healthnet Hmo/Ppo	$5,633 - $11,266	461%
Blue Shield Aco	$5,769 - $11,537	472%
Blue Cross Blue Shield	$7,507 - $9,492	614%
Cigna	$15,538	1271%

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 $7,023.
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 Marinhealth 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.