CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cleveland Clinic Avon Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,960
Cash Discount Price: $3,158
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cleveland Clinic Avon Hospital is $1,960. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,158. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.60x the Medicare baseline. Located in 33300 Cleveland Clinic Blvd, Avon, OH.

Cash / Self-Pay

$3,158

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,960

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: $3,158 (258%)

Insurance Median: $1,960 (160%)

Cash: $3,158 (258% of Medicare)

Ins. Median: $1,960 (160% 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
Blue Cross Blue Shield	$752 - $3,806	62%
Buckeye	$752	62%
Molina	$752	62%
Caresource	$766	63%
United	$766 - $4,338	63%
Aetna	$1,093 - $4,858	89%
Devoted Health	$1,093	89%
Humana	$1,093	89%
Mmo	$1,093 - $2,345	89%
Summacare	$1,093 - $1,953	89%
The Health Plan	$1,093 - $2,915	89%
UnitedHealthcare	$1,093 - $3,012	89%
Upmc	$1,093 - $2,915	89%
Valor	$1,093	89%
Cigna	$1,126 - $2,531	92%
Communicare	$1,148	94%
Perennial Health	$1,180	97%
Pphp	$1,202	98%
Zing Health	$1,202	98%
Oscar	$1,464 - $1,868	120%
Cc Ehp	$1,938 - $1,967	159%
Aultcare	$2,089	171%
Amish Community Aid Plan	$2,186 - $2,429	179%
Ohcp	$2,361	193%
Omas	$2,429	199%
Ohio Healthy	$2,623	215%
Php	$2,915	238%
Gms	$3,401	278%
Medical Benefit Corp	$3,401	278%
Consociate Health	$3,644	298%
Frontpath	$4,372	358%
Managed Care Services	$4,372	358%
Multiplan	$4,372	358%
Tertiary Care Network	$4,372	358%

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 $3,158.
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 Avon 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.