CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Sarasota Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $655
Cash Discount Price: $2,110
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Sarasota Memorial Hospital is $655. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,110. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.54x the Medicare baseline. Located in 1700 S Tamiami Trl, Sarasota, FL.

Cash / Self-Pay

$2,110

Average discount available for prompt cash payment at this facility.

Insurance Median

$655

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: $2,110 (173%)

Insurance Median: $655 (54%)

Cash: $2,110 (173% of Medicare)

Ins. Median: $655 (54% 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.

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
Simply Healthcare Oncology	$160 - $344	13%
Sunshine State Oncology	$160 - $344	13%
Molina Oncology	$164 - $354	13%
Amerihealth Caritas Oncology	$167 - $360	14%
Community Care Plan Oncology	$167 - $360	14%
Blue Cross Blue Shield	$193 - $1,184	16%
Florida Community Care Oncology	$201 - $521	16%
Wellcare Oncology	$212 - $447	17%
Simply Freedom Optimum Oncology	$215 - $469	18%
Aetna	$225 - $4,729	18%
UnitedHealthcare	$435 - $3,961	36%
Ambetter / Centene	$531 - $3,196	43%
Simply Healthcare	$637 - $669	52%
Sunshine State	$669	55%
Molina	$688	56%
Amerihealth Caritas	$701	57%
Community Care Plan	$701	57%
Florida Community Care	$701 - $1,302	57%
Oscar Oncology	$713	58%
Simply Freedom Optimum	$1,243	102%
Wellcare	$1,243	102%
Oscar Health	$2,032	166%
Careworks	$2,558 - $3,533	209%
Enlyte	$2,558 - $3,533	209%
Avmed	$3,850	315%
Usa Managed Care	$4,219	345%
First Health	$4,377	358%

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 $2,110.
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 Sarasota 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.