CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Johnson Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,013
Cash Discount Price: $2,928
vs. Medicare Baseline: 2.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Johnson Memorial Hospital is $3,013. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,928. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.46x the Medicare baseline. Located in 201 Chestnut Hill Road, Stafford Springs, CT.

Cash / Self-Pay

$2,928

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,013

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: $2,928 (239%)

Insurance Median: $3,013 (246%)

Cash: $2,928 (239% of Medicare)

Ins. Median: $3,013 (246% 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 246% of the Medicare baseline (a markup of 146%). 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
Connecticut Dept Of Correction	$1,325	108%
Aetna	$1,406	115%
Blue Cross Blue Shield	$1,406 - $3,371	115%
Medicare (plans)	$1,406 - $1,478	115%
UnitedHealthcare	$1,406	115%
Cca Senior Care Options	$1,434	117%
Cigna	$1,448	118%
Fallon Health	$1,865	153%
Claimdoc	$3,013	246%
Diversified Administrators	$3,013	246%
Innovative Health Plan Ii	$3,013	246%
Centivo	$3,343	273%
Bcn Domestic	$3,371	276%
Blue Benefit Administrators Of Massachusetts	$3,371	276%
Blue Care Network	$3,371	276%
Blue Distinction Transplant	$3,371	276%
Blue Shield - Ca	$3,371	276%
Blue Shield - Id (Regence)	$3,371	276%
Blue Shield - Ny Highmark Northeastern	$3,371	276%
Blue Shield - Ny Highmark Western	$3,371	276%
Blue Shield - Pa (Highmark)	$3,371	276%
Blue Shield - Wa (Regence)	$3,371	276%
Health Choices	$3,371	276%
Kaiser Domestic	$3,371	276%
Pre-Employment	$3,371	276%
Unicare	$3,371	276%
Wc Domestic	$3,371	276%
Wellpoint	$3,371	276%

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 $2,928.
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 Johnson Memorial 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.