CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $189
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Munson Healthcare Otsego Memorial Hospital is $189. 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 0.15x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$189

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: $189 (15%)

Ins. Median: $189 (15% 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
Blue Cross Blue Shield	$58 - $624	5%
Mclaren Health Plan	$127 - $624	10%
Meridian	$127 - $624	10%
Molina	$127 - $624	10%
Priority Health	$127 - $1,129	10%
UnitedHealthcare	$127 - $624	10%
Blue Care Network	$175	14%
Hap (Health Alliance Plan)	$175 - $263	14%
Humana	$175	14%
Medicare (plans)	$175 - $1,192	14%
Michigan Amish Medical Board	$175	14%
Northern Michigan Mennonite Group	$175	14%
Aetna	$177	14%
Asr Physicians Care Network	$263	22%
Nomi Health	$281	23%
Employee Benefit Logistics	$298	24%
Cigna	$362 - $1,129	30%

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 Munson Healthcare Otsego Memorial 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.