CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Covenant Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $452
Cash Discount Price: $341
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Covenant Medical Center is $452. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.37x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$452

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: $341 (28%)

Insurance Median: $452 (37%)

Cash: $341 (28% of Medicare)

Ins. Median: $452 (37% 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
Health Advantage Mclaren Employee	$219	18%
Priority Health E	$224	18%
Physicians Health Plan	$268	22%
Priority Health	$268 - $1,223	22%
Blue Care Network	$317 - $1,223	26%
Blue Cross Blue Shield	$317 - $1,009	26%
Aetna	$334 - $1,223	27%
Humana	$365 - $1,223	30%
Meritain Health	$373	31%
Mclaren Health Advantage	$420	34%
Multiplan	$438	36%
Health Alliance Plan Of Michigan	$452 - $2,360	37%
Healthy Michigan Mclaren	$452 - $639	37%
Healthy Michigan Meridian	$452 - $639	37%
Healthy Michigan Molina	$452 - $639	37%
Healthy Michigan Priority Health	$452 - $639	37%
Mclaren Advantage	$452 - $1,223	37%
Molina Healthplan	$452 - $1,223	37%
Physicians Health Plan Advantage/Advantage Plus	$452 - $1,223	37%

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 $341.
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 Covenant 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.