CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Ochsner St Mary

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,073
Cash Discount Price: $1,040
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Ochsner St Mary is $1,073. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,040. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.88x the Medicare baseline. Located in 1125 Marguerite Street, Morgan City, LA.

Cash / Self-Pay

$1,040

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,073

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: $1,040 (85%)

Insurance Median: $1,073 (88%)

Cash: $1,040 (85% of Medicare)

Ins. Median: $1,073 (88% 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
Tricare	$455 - $1,149	37%
Healthy Blue (Healthy Louisiana)	$481	39%
Humana	$481 - $1,073	39%
Louisiana Healthcare Connections (Healthy Louisiana)	$481	39%
UnitedHealthcare	$481 - $2,616	39%
Aetna	$496 - $4,435	41%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$496	41%
Blue Cross Blue Shield	$1,011 - $1,169	83%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$1,073	88%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$1,073	88%
Medicare (plans)	$1,073	88%
Ochsner Health Plan	$1,073	88%
Claritev D/B/A Multiplan/Phcs/American Life Care	$1,516	124%
Zelis	$1,615	132%
Verity Commercial And First Choice Network	$2,808	230%
Cigna	$3,026	248%
First Health Network	$3,484	285%
Healthcomp & Personify Health (Formerly Gilsbar)	$3,640	298%

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 $1,040.
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 Ochsner St Mary 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.