CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adena Pike Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $4,789
Cash Discount Price: $3,178
vs. Medicare Baseline: 3.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Adena Pike Medical Center is $4,789. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,178. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.92x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$3,178

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,789

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: $3,178 (260%)

Insurance Median: $4,789 (392%)

Cash: $3,178 (260% of Medicare)

Ins. Median: $4,789 (392% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 392% of the Medicare baseline (a markup of 292%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$1,525 - $5,173	125%
Blue Cross Blue Shield	$1,525 - $5,484	125%
Buckeye Community Health Plan	$1,525	125%
Humana	$1,525 - $6,037	125%
Medical Mutual Of Ohio	$1,525 - $4,039	125%
Medigold	$1,525	125%
Molina	$1,525	125%
Care Source	$1,556	127%
Gateway Health	$2,097	172%
Molina Marketplace	$2,501	205%
UnitedHealthcare	$2,665	218%
Care Source Just4Me	$2,745	225%
Sidecar Health	$4,194	343%
Ohio Ppo Connect	$4,449	364%
The Health Plan	$4,449	364%
Cigna	$4,601	376%
Medical Mutual Of Ohio Supermed	$4,789	392%
First Health	$4,982	408%
Ohio Health Choice	$5,059	414%
Integrated Health Plan	$5,974	489%
Healthsmart	$6,037	494%
Multiplan/Private Healthcare Systems	$6,037	494%
Three Rivers Network	$6,037	494%

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 $3,178.
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 Adena Pike 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.