CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Hillcrest Hospital Claremore

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $5,957
Cash Discount Price: $4,536
vs. Medicare Baseline: 4.87x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Hillcrest Hospital Claremore is $5,957. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,536. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 4.87x the Medicare baseline. Located in 1202 N Muskogee Place, Claremore, OK.

Cash / Self-Pay

$4,536

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,957

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: $4,536 (371%)

Insurance Median: $5,957 (487%)

Cash: $4,536 (371% of Medicare)

Ins. Median: $5,957 (487% 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 487% of the Medicare baseline (a markup of 387%). 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
Black Lung [6055]	$3,780	309%
Healthcare Highways [2210]	$3,780 - $5,957	309%
Hooray Health [8000]	$3,780	309%
Lucent Health [6000]	$3,780	309%
Oncology Patient Assistance Programs [2295]	$3,780	309%
Oscar Insurance Company [7005]	$3,780	309%
Osma Health Network [2345]	$3,780	309%
UnitedHealthcare	$5,931	485%
Resource One Administrators [2815]	$5,957	487%
Web Tpa [2115]	$5,957	487%
Beacon Health Options Behavioral Health [2890]	$6,501	532%
The Kempton Group Administrators [2905]	$6,804	557%
Pba [1775]	$7,529	616%
Medica [2910]	$8,542	699%

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 $4,536.
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 Hillcrest Hospital Claremore 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.