CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adventist Health Howard Memorial

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $341
Cash Discount Price: $203
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Adventist Health Howard Memorial is $341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $203. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.28x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$203

Average discount available for prompt cash payment at this facility.

Insurance Median

$341

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: $203 (17%)

Insurance Median: $341 (28%)

Cash: $203 (17% of Medicare)

Ins. Median: $341 (28% 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	$135 - $178	11%
Tricare	$135 - $178	11%
Medicare (plans)	$137 - $178	11%
UnitedHealthcare	$149 - $524	12%
Ah Employee Health Plan - All Plans	$196 - $352	16%
Cigna	$235 - $575	19%
Aetna	$248 - $454	20%
Western Growers/Pinnacle - All Plans	$254 - $508	21%
Healthnet - All Plans	$259 - $555	21%
Medi-Cal	$330	27%
First Health Ppo - All Plans	$542	44%
Ghn Ppo - All Plans	$542	44%
Brms - All Plans	$575	47%
Blue Shield - All Other Plans	$743 - $8,286	61%
Blue Cross Blue Shield	$828 - $7,520	68%
Blue Shield Epn	$8,005	655%

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 $203.
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 Howard Memorial 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.