CMS Price Transparency Data

Colonoscopy with biopsy

Facility: HCA Florida North Florida Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,548
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at HCA Florida North Florida Hospital is $3,548. 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 2.90x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,548

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: $3,548 (290%)

Ins. Median: $3,548 (290% 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 290% of the Medicare baseline (a markup of 190%). 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
Molina Healthcare	$1,950 - $3,242	160%
Simply	$2,250	184%
Blue Cross Blue Shield	$2,347 - $4,315	192%
Corvel Corporation	$2,490 - $3,371	204%
Prime Health	$2,543 - $3,442	208%
Careworks (Rockport Community)	$2,621 - $3,548	214%
Simply Healthcare	$2,762	226%
Oscar	$3,370	276%
Capital Health Plan	$3,765 - $4,521	308%
Evolutions	$4,121	337%
Avmed	$7,042 - $16,238	576%
United	$8,440	690%
Ultimate Health Plan	$12,500	1022%
Cigna	$14,857 - $35,535	1215%

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 HCA Florida North Florida 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.