CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Avita Ontario

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,254
Cash Discount Price: $4,410
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Avita Ontario is $2,254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,410. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.84x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$4,410

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,254

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: $4,410 (361%)

Insurance Median: $2,254 (184%)

Cash: $4,410 (361% of Medicare)

Ins. Median: $2,254 (184% 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
Caresource	$1,502	123%
Medicaid / KanCare	$1,502	123%
Molina	$1,502 - $5,629	123%
Ohiorise	$1,502	123%
United_Healthcare	$1,502 - $4,410	123%
Blue Cross Blue Shield	$1,547 - $3,518	127%
Amerihealth	$1,577	129%
Buckeye	$1,625 - $3,518	133%
Humana	$1,625 - $3,518	133%
Aetna	$1,816 - $4,410	149%
Medicare (plans)	$1,816 - $3,518	149%
Mount_Carmel	$1,816 - $3,518	149%
Medical_Mutual	$1,852 - $4,150	151%
Cigna	$4,041	331%

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 $4,410.
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 Avita Ontario 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.