CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Modoc Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,196
Cash Discount Price: $2,671
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Modoc Medical Center is $2,196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,671. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.80x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$2,671

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,196

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: $2,671 (218%)

Insurance Median: $2,196 (180%)

Cash: $2,671 (218% of Medicare)

Ins. Median: $2,196 (180% 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
Adv Med Mgmt - All Plans	$330	27%
Medi-Cal	$330	27%
Medi-Cal 7/1/24	$330	27%
Partnership Hp - All Plans	$1,156	95%
Multiplan Wc	$1,161	95%
Ntwrks By Design Wc - All Plans	$1,210	99%
Integrated Hp Wc	$1,223	100%
Blue Shield Mcr Adv	$1,446	118%
Blue Shield Va	$1,446	118%
UnitedHealthcare	$1,446 - $2,537	118%
Tricare	$1,522	124%
Healthnet Mcr Adv	$1,537	126%
Blue Shield Comm - All Other Plans	$1,800	147%
Blue Shield Exch	$2,195	180%
Blue Cross Blue Shield	$2,196 - $2,440	180%
Carelon - All Plans	$2,440	200%
Corvel - All Plans	$2,510	205%
Aetna	$2,537	208%
Coventry/First Health - All Plans	$2,537	208%
Galaxy Health - All Plans	$2,537	208%
Healthnet Comm - All Other Plans	$2,537	208%
Hmn - All Plans	$2,537	208%
Integrated Hp - All Other Plans	$2,537	208%
Interplan - All Plans	$2,537	208%
Multiplan - All Other Plans	$2,537	208%
Superior Ca Ppo - All Plans	$2,537	208%

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 $2,671.
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 Modoc 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.