CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Prisma Health Hillcrest Hospital
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $1,198
- Cash Discount Price: $2,439
- vs. Medicare Baseline: 0.98x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Prisma Health Hillcrest Hospital is $1,198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,439. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.98x the Medicare baseline. Located in 741 South East Main Street, Simpsonville, SC.
Cash / Self-Pay
$2,439
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,198
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: $2,439 (199%)
Insurance Median: $1,198 (98%)
Cash: $2,439 (199% of Medicare)
Ins. Median: $1,198 (98% 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.
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 | $578 - $1,096 | 47% |
| UnitedHealthcare | $578 - $5,804 | 47% |
| Promise Health Plan Contracted [2401] | $579 - $2,251 | 47% |
| Bob Jones Univ-Pai [821] | $789 - $1,249 | 65% |
| Blue Cross Blue Shield | $833 - $2,455 | 68% |
| Sc Dept Of Corrections [2998] | $833 | 68% |
| Scdc-Sc Dept Of Corrections [7232] | $833 | 68% |
| Prisma Health Seniorcare Pace - Midlands [5400] | $870 | 71% |
| Prisma Health Seniorcare Pace-Upstate [5200] | $870 | 71% |
| First Choice Benefits Mgmt [3074] | $1,044 | 85% |
| Medicare (plans) | $1,044 - $1,255 | 85% |
| Tricare | $1,097 | 90% |
| Humana | $1,117 - $1,170 | 91% |
| Champva [3049] | $1,141 | 93% |
| Cigna | $1,141 - $2,604 | 93% |
| Covid19 Hrsa Uninsured Testing & Treatment Fund [904] | $1,141 | 93% |
| Deseret Mutual Ins Co [3066] | $1,141 | 93% |
| Generic Skilled Nursing [3196] | $1,141 | 93% |
| Hospice Contracted [1500] | $1,141 | 93% |
| Hospice Non Contracted [3190] | $1,141 | 93% |
| Triwest Healthcare Alliance Vcp [902] | $1,141 | 93% |
| Va Community Care Network-Vaccn [903] | $1,141 | 93% |
| Veterans Administration [3194] | $1,141 | 93% |
| Aetna | $1,198 - $2,964 | 98% |
| Healthy Conn Prime-Wellcare Prime By Atc [5310] | $1,198 | 98% |
| Healthy Conn Prime-First Choice Vip Care [5300] | $1,209 | 99% |
| Healthy Conn Prime-Molina Healthcare [5330] | $1,255 | 103% |
| Orangeburg Senior Helping Center Pace [5401] | $1,501 | 123% |
| Bluechoice [810] | $1,584 - $2,592 | 130% |
| Workers Comp [600] | $1,597 | 131% |
| Ambetter / Centene | $2,099 | 172% |
| Meritain Health Contracted [2200] | $2,401 - $2,964 | 196% |
| Planned Administrators [820] | $2,455 | 201% |
| Evernorth Behavioral Contracted [2982] | $2,604 | 213% |
| Mvp Health Care [3037] | $2,604 | 213% |
| Preferred Administrators Contracted [2839] | $2,626 | 215% |
| Medcost [2940] | $2,776 - $3,114 | 227% |
| Atlantic Packaging Contracted [4833] | $2,814 | 230% |
| Aps Healthcare System [2981] | $3,002 | 246% |
| Multiplan/Phcs Contracted [2950] | $3,339 | 273% |
| Vsp Vision Care [2986] | $3,377 | 276% |
| First Health Contracted [2952] | $3,489 | 285% |
| Furman Int/Allen University Student [2951] | $3,489 | 285% |
| Quiktrip-First Health [3067] | $3,489 | 285% |
| Golden Rule Insurance Company [2991] | $5,804 | 475% |
| Oxford Health Plans [2992] | $5,804 | 475% |
| Zzumr-Salt Lake City Ut [3169] | $5,804 | 475% |