CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Forks Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,474
Cash Discount Price: $3,720
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Forks Community Hospital is $2,474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,720. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.02x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$3,720

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,474

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: $3,720 (304%)

Insurance Median: $2,474 (202%)

Cash: $3,720 (304% of Medicare)

Ins. Median: $2,474 (202% 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 202% of the Medicare baseline (a markup of 102%). 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
Medicare (plans)	$318	26%
Medicaid / KanCare	$1,410 - $2,106	115%
Coordinated Care (Mco) Mcd-All Plans	$1,523 - $2,146	125%
UnitedHealthcare	$1,815 - $4,884	148%
Community Health Network Mcr-All Other Plans	$1,835 - $2,586	150%
Humana	$1,835 - $2,586	150%
Tricare	$1,835 - $2,586	150%
Triwest-All Plans	$1,835 - $2,586	150%
Ambetter / Centene	$2,128 - $2,999	174%
Wellcare Med Adv - All Plans	$2,128 - $2,999	174%
Regence-All Other Plans	$2,348 - $3,309	192%
Community Health Exchange	$2,650 - $3,735	217%
Molina Commercial-All Other Plans	$3,751 - $5,286	307%
Blue Cross Blue Shield	$3,873 - $5,459	317%
Aetna	$4,077 - $5,746	333%
Cigna	$4,077 - $5,746	333%
First Choice-All Plans	$4,077 - $5,746	333%

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 $3,720.
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 Forks Community 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.