CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Good Samaritan Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,791
Cash Discount Price: $2,618
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Good Samaritan Hospital is $1,791. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,618. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.46x the Medicare baseline. Located in 375 Dixmyth Avenue, Cincinnati, OH.

Cash / Self-Pay

$2,618

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,791

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: $2,618 (214%)

Insurance Median: $1,791 (146%)

Cash: $2,618 (214% of Medicare)

Ins. Median: $1,791 (146% 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
Aetna	$538 - $1,791	44%
Oscar	$1,016 - $1,749	83%
Medical Mutual Of Ohio	$1,189	97%
Buckeye	$1,201 - $1,691	98%
Blue Cross Blue Shield	$1,458 - $3,586	119%
UnitedHealthcare	$2,071	169%
Imagine Health	$2,797	229%
Custom Design Benefits	$2,869 - $2,997	235%
Medben	$3,195 - $3,359	261%

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 $2,618.
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 Good Samaritan 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.