CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Vincent's Birmingham

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,860
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Vincent's Birmingham is $3,860. 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 3.16x the Medicare baseline. Located in 810 St Vincent's Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,860

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: $3,860 (316%)

Ins. Median: $3,860 (316% 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 316% of the Medicare baseline (a markup of 216%). 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
Ambetter / Centene	$166 - $1,505	14%
Aetna	$856 - $3,217	70%
Blue Cross Blue Shield	$1,051	86%
Cooper Green	$1,095	90%
UnitedHealthcare	$1,095 - $2,528	90%
Humana	$1,106 - $3,860	90%
Cigna	$1,127 - $3,320	92%
Prime Health Services	$1,149 - $5,414	94%
Seven Corners	$1,478	121%
Viva	$3,524 - $3,860	288%
Construction Claims Management	$4,244 - $4,649	347%
Corvel	$4,244 - $4,649	347%
Alamed	$4,494 - $4,922	368%
Comp One	$4,494 - $4,922	368%
Multiplan	$4,699 - $5,147	384%
Pnoa	$4,699 - $5,147	384%
Novanet	$4,993 - $5,469	408%

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 St Vincent's Birmingham 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.