CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Southern Ohio Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$601

about 0.5× the $1,223 Medicare rate · typically $254–$898

modeled estimate · not a bill or quote

What this hospital charges insurers

$416

Below the fair price — a good deal

about $185 under the fair price · 0.3× Medicare

Medicare pays $1,223 Fair price $601 This hospital $416 Cash price $400 Hospital's list price $800

How we calculate the fair BaseRate →

How this hospital compares to other OH hospitals

A typical price — 3 charge more and 5 charge less, among the 9 OH hospitals compared.

Cheapest $175 Priciest $727

Black dot = this hospital, among the 9 OH hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $601 (about 0.5× the $1,223 Medicare rate). Southern Ohio Medical Center charges insurers about $416, or about $400 in cash — below the fair price — a good deal. Located in Portsmouth, OH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$213 - $704	17%
Blue Cross Blue Shieldmajor	$203 - $1,089	17%
Aetnamajor	$397 - $1,132	32%
Cignamajor	$358 - $664	29%
Humanamajor	$275 - $1,089	22%
Ambetter (Centene)	$188	15%
CareSource	$225 - $1,471	18%
Medical Mutual	$188 - $656	15%
Molina	$188 - $1,307	15%
WellCare	$188 - $420	15%
+ 6 smaller / regional plans	$188 - $1,525

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 400), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Southern Ohio Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Southern Ohio Medical Center

Compare: Colonoscopy with biopsy at other OH hospitals

Insurance negotiated median for the same procedure, sorted lowest first.