CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mayers Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,167
Cash Discount Price: $2,618
vs. Medicare Baseline: 1.77x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mayers Memorial Hospital is $2,167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,618. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.77x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$2,618

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,167

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: $2,618 (214%)

Insurance Median: $2,167 (177%)

Cash: $2,618 (214% of Medicare)

Ins. Median: $2,167 (177% 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 Ca Va	$169 - $2,058	14%
Blue Shield Mcr Adv	$169 - $2,058	14%
Tricare	$169 - $2,167	14%
Health Net Mcr Adv	$178 - $2,167	15%
Arcadian Health Services-All Plans	$187 - $2,167	15%
Imperial Health Plan-All Plans	$201 - $2,448	16%
Medi-Cal	$330	27%
Partnership Hp-All Plans	$1,321	108%
Cigna	$1,854 - $3,119	152%
Corvel Ppo-All Plans	$1,854 - $3,119	152%
Coventry/First Health-All Plans	$1,854 - $3,119	152%
Integrated Hp-All Plans	$1,854 - $3,119	152%
Interplan-All Plans	$1,854 - $3,119	152%
Blue Cross Blue Shield	$2,188 - $2,807	179%
Health Net Prison	$2,362	193%
Blue Shield Ca Exchange	$2,807	230%
Blue Shield-All Other Plans	$3,119	255%
Hmn-All Plans	$3,119	255%
Multiplan Phcs-All Plans	$3,119	255%
Pfmc-All Plans	$3,119	255%
Superior Ca-All Plans	$3,119	255%
Health Net-All Other Plans	$3,267	267%
Pacificare-All Plans	$3,283	269%

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 $2,618.
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 Mayers Memorial 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.