CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kau Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $200
Cash Discount Price: $549
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Kau Hospital is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $549. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.16x the Medicare baseline. Located in 1 Kamani Street, Pahala, HI.

Cash / Self-Pay

$549

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

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: $549 (45%)

Insurance Median: $200 (16%)

Cash: $549 (45% of Medicare)

Ins. Median: $200 (16% 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
Hawaii Medical Service Association	$178 - $413	15%
Alohacare	$178 - $200	15%
UnitedHealthcare	$178 - $200	15%
Ohana Health Plan	$178 - $200	15%
Devoted Health	$196	16%
Kaiser Permanente	$214	18%
Hawaii Western Management Group	$352	29%
University Health Alliance	$400	33%
Health Management Network	$777	64%

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 $549.
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 Kau 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.