CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Baldwin Health

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45380
  • Insurance Median: $1,358
  • Cash Discount Price: $4,716
  • vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Baldwin Health is $1,358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,716. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.11x the Medicare baseline. Located in 1613 North McKenzie Street, Foley, AL.
Cash / Self-Pay
$4,716

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,358

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: $4,716 (386%)
Insurance Median: $1,358 (111%)
Cash: $4,716 (386% of Medicare)
Ins. Median: $1,358 (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.

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
Veterans Eval Services $371 30%
Medicaid / KanCare $383 31%
Tricare $1,078 88%
Triwest $1,112 91%
Blue Cross Blue Shield $1,117 - $1,340 91%
Humana $1,117 91%
Medicare (plans) $1,117 91%
UnitedHealthcare $1,117 - $7,154 91%
Windsor Health Plan $1,117 91%
Community Hospice $1,135 93%
Hospice $1,135 93%
Mercy Medical Hospice $1,135 93%
Node Champva $1,135 93%
Node Va $1,135 93%
Cigna $1,139 - $4,167 93%
Node Devoted Health Mcr Adv $1,139 93%
Node Clover Health Mcr Adv $1,147 94%
Select Health $1,147 94%
Aetna $1,151 - $23,578 94%
Node Wellcare Mcr Adv $1,158 95%
Us Dol $1,419 116%
Ambetter / Centene $1,703 139%
First Choice $1,839 150%
Self Pay $4,716 386%
American Employee Alliance $10,479 857%
Multiplan $14,933 - $21,483 1221%
First Health $19,649 - $21,155 1607%
Alamed $20,042 1639%
Multiplan Inc $20,042 1639%
Coventry Work Comp Al $20,487 1676%
One Health $20,959 1714%
Pro America $20,959 1714%
Novanet $21,155 1730%
Alabama Wc $22,269 1822%
Gulf Health $22,269 1822%
Principal Ppo $22,269 1822%
Viva Health $22,269 1822%
National Health $23,578 1929%
Galaxy $23,840 1950%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1613 North McKenzie Street, Foley, AL 36535
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals