CMS Price Transparency Data

Colonoscopy with biopsy

Facility: OHSU Hospital and Clinics

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,356
Cash Discount Price: $2,958
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at OHSU Hospital and Clinics is $1,356. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,958. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.11x the Medicare baseline. Located in 3181 Sw Sam Jackson Park Road, Portland, OR.

Cash / Self-Pay

$2,958

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,356

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: $2,958 (242%)

Insurance Median: $1,356 (111%)

Cash: $2,958 (242% of Medicare)

Ins. Median: $1,356 (111% 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
Care Oregon	$538 - $1,586	44%
Intercommunity Health Network	$538 - $1,075	44%
Kaiser Foundation Hospitals	$538 - $3,124	44%
Medicare (plans)	$538 - $2,150	44%
Pacific Source	$538 - $3,541	44%
Humana	$672 - $1,424	55%
Trillium	$672 - $1,344	55%
Moda	$705 - $4,551	58%
UnitedHealthcare	$712 - $4,551	58%
Aetna	$726 - $3,550	59%
Health Net Health Plan Of Oregon, Inc.	$773 - $3,525	63%
Providence Health Plan	$806 - $4,551	66%
Community Health Plan Of Washington	$874 - $1,881	71%
Tuality Health	$1,209 - $2,419	99%
Samaritan Health Plan	$1,680 - $3,359	137%
Blue Cross Blue Shield	$1,850 - $3,700	151%
Cigna	$2,080 - $4,160	170%
Coventry First Health	$3,413	279%
First Choice	$3,448	282%
Molina Exchange	$4,551	372%

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 $2,958.
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 OHSU Hospital and Clinics 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.