CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Lost Rivers Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,022
Cash Discount Price: $1,696
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Lost Rivers Medical Center is $2,022. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,696. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.65x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$1,696

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,022

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: $1,696 (139%)

Insurance Median: $2,022 (165%)

Cash: $1,696 (139% of Medicare)

Ins. Median: $2,022 (165% 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
Select Health Brightpath-All Other Plans	$398 - $1,915	33%
Ihcn Brightpath-All Other Plans	$420 - $2,022	34%
Va Pccc-All Plans	$429 - $3,209	35%
Blue Cross Blue Shield	$442 - $3,378	36%
Humana	$442 - $3,378	36%
Ihcn Brightpath Mcr Adv	$442 - $2,128	36%
Molina Mcr Adv-All Plans	$442 - $2,128	36%
Pacificsource Mcr Adv	$442 - $2,128	36%
Regence/Brightpth Slhp Mcr	$442 - $2,128	36%
Select Health Mcr Adv	$442 - $2,128	36%
Prime Hlth Mcr Adv	$464 - $2,235	38%
Tricare	$488 - $1,915	40%
First Choice-All Plans	$801 - $3,142	66%
Aetna	$809 - $3,175	66%
Pacificsource Navigator-All Other Plans	$818 - $3,209	67%
Altius Health Plan-All Plans	$835 - $3,277	68%
Regence Blue Shield-All Other Plans	$844 - $3,310	69%
Provider Network Of America-All Plans	$2,201	180%
Cigna	$3,142	257%
UnitedHealthcare	$3,209	262%

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 $1,696.
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 Lost Rivers Medical Center 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.