CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Martin Luther King, Jr. Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,462
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Martin Luther King, Jr. Community Hospital is $1,462. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.20x the Medicare baseline. Located in 1680 East 120Th Street, Los Angeles, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,462

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%)

Insurance Median: $1,462 (120%)

Ins. Median: $1,462 (120% 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
Preferred Professional Medical Corporation (Ipa) Of California	$149 - $923	12%
Alta	$330 - $1,539	27%
Brand New Day	$330 - $1,539	27%
Care1St Health	$330 - $1,539	27%
Molina Healthcare	$347 - $1,924	28%
La Care Health	$594	49%
Health Net	$859 - $1,745	70%
Santa Monica Unite Here	$1,321	108%
Heritage Provider Network (Hpn)	$1,462	120%
La Care Health Pasc-Seui	$1,801	147%
La Care Health Plan	$1,801	147%

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 $X.
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 Martin Luther King, Jr. Community 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.