CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $914
Cash Discount Price: $760
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cincinnati Children's Hospital Medical Center is $914. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $760. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.75x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$760

Average discount available for prompt cash payment at this facility.

Insurance Median

$914

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: $760 (62%)

Insurance Median: $914 (75%)

Cash: $760 (62% of Medicare)

Ins. Median: $914 (75% 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	$144 - $1,491	12%
Humana	$151 - $213	12%
Wellcare_Ky	$151 - $201	12%
United_Health_Care_Ky	$152 - $202	12%
Blue Cross Blue Shield	$181 - $1,491	15%
Caresource_Oh	$181 - $213	15%
Amerihealth_Caritas_Oh	$186 - $219	15%
Molina_Oh	$190 - $223	16%
Buckeye_Oh	$198 - $233	16%
Passport_Ky	$199	16%
United_Health_Care_Oh	$215 - $253	18%
Caresource_In	$262 - $349	21%
Caresource_Oh_Insurance	$746	61%
Medical_Mutual_Of_Ohio_Insurance	$798 - $1,357	65%
Parkview_Signature_Care_Insurance	$914 - $1,075	75%
Point_Comfort_Insurance	$969	79%
Margaret_Mary_Health_Insurance	$989 - $1,163	81%
Cigna	$1,014 - $1,193	83%
Health_Ohio_Network_Insurance	$1,193 - $1,416	98%
Beechstreet_Insurance	$1,204 - $1,416	98%
Evolutions_Health_Care_Systems	$1,342	110%
Galaxy_Health_Insurance	$1,342	110%
United_Health_Care_Insurance	$1,385 - $1,491	113%
Custom_Design_Benefits_Insurance	$1,416	116%
First_Health_Group_Insurance	$1,416	116%
Health_Link_Insurance	$1,416	116%
Health_Smart_Preferred_Insurance	$1,416	116%
Medical_Benefit_Administrators_Insurance	$1,416	116%
Ohio_Health_Choice_Insurance	$1,416	116%
Private_Health_Care_Systems_Insurance	$1,491	122%

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 $760.
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 Cincinnati Children's Hospital 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.