CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Clarion Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,168
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Clarion Hospital is $1,168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.96x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,168

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%)

Insurance Median: $1,168 (96%)

Ins. Median: $1,168 (96% 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
Medicaid / KanCare	$225	18%
Amerihealth	$248 - $1,134	20%
Jefferson Health Plan	$248	20%
Geisinger	$273 - $1,191	22%
Upmc	$282 - $1,806	23%
Workers Comp	$875	72%
Highmark	$1,123 - $1,882	92%
Highmark Community Blue	$1,130	92%
Cigna	$1,134	93%
Martin'S Point - Usfhp	$1,134	93%
Medicare (plans)	$1,134	93%
Tricare	$1,134	93%
UnitedHealthcare	$1,134	93%
Aetna	$1,168 - $2,609	96%
Devoted Health Plan	$1,202	98%
The Health Plan	$1,202 - $2,666	98%
Gateway	$1,214	99%
Pa Health & Wellness	$1,214	99%
American Health Plan	$1,248	102%
Highmark - Ind.& Managed Care	$2,547	208%
Peak Health	$2,666	218%

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 $X.
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 Clarion Hospital 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.