CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Adventist Health Castle

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $277
Cash Discount Price: $157
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Adventist Health Castle is $277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.23x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$277

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: $157 (13%)

Insurance Median: $277 (23%)

Cash: $157 (13% of Medicare)

Ins. Median: $277 (23% 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
Alohacare Quest Mcaid - All Other Plans	$178	15%
Kfh Mcr Adv	$178	15%
Medicare (plans)	$178	15%
UnitedHealthcare	$178	15%
Devoted Hlth Mcr Adv - All Plans	$184	15%
Alohacare Mcr Adv Profee Only	$187	15%
Hmsa Quest Abd	$208	17%
Multiplan Hmn - All Plans	$277	23%
Hwmg/Hmaa - All Plans	$352	29%
State Of Hi Nonprofit - All Plans	$401	33%
Hmsa Ppo - All Other Plans	$413	34%
Hmsa Hmo	$432	35%
First Health Ppo - All Plans	$462	38%
Medicaid / KanCare	$492	40%
Ohana Health Plan - All Plans	$492	40%
Mdx Hawaii Ppo - All Plans	$563	46%

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 $157.
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 Adventist Health Castle 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.