CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $387
Cash Discount Price: $995
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cleveland Clinic Indian River Hospital is $387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $995. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.32x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$995

Average discount available for prompt cash payment at this facility.

Insurance Median

$387

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: $995 (81%)

Insurance Median: $387 (32%)

Cash: $995 (81% of Medicare)

Ins. Median: $387 (32% 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
Avmed	$204 - $2,710	17%
Blue Cross Blue Shield	$204 - $4,699	17%
Careplus	$204 - $1,184	17%
Magellan	$204	17%
United	$204 - $2,728	17%
Value Options	$204 - $327	17%
Wellcare	$204 - $1,184	17%
Freedom Health	$215 - $1,184	18%
Independent Living Systems	$215 - $1,243	18%
Wellmed	$215 - $1,184	18%
Clear Spring Health	$221	18%
Aetna	$245 - $4,061	20%
UnitedHealthcare	$311	25%
Cigna	$326 - $418	27%
Amerihealth	$327	27%
Medicaid / KanCare	$327	27%
Molina	$327	27%
Clarity Health	$995	81%
The Legacy Companies	$995	81%
National Provider Network	$1,072	88%
Three Rivers	$1,072	88%
Consociate Health	$1,148	94%
Carelon Bh Strategies	$1,184	97%
Humana	$1,184	97%
Devoted Health	$1,302	106%

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 $995.
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 Cleveland Clinic Indian River 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.