CMS Price Transparency Data

Colonoscopy with biopsy

Facility: University of Michigan Health - West

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $501
Cash Discount Price: $240
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at University of Michigan Health - West is $501. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.41x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$240

Average discount available for prompt cash payment at this facility.

Insurance Median

$501

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: $240 (20%)

Insurance Median: $501 (41%)

Cash: $240 (20% of Medicare)

Ins. Median: $501 (41% 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
Medicaid / KanCare	$141 - $655	12%
Priority Health	$264	22%
Web Tpa	$264	22%
Aetna	$402	33%
Alliance Health & Life Ppo	$402	33%
Asr Physicians	$402	33%
Hap	$402	33%
Golden Rule Ins	$433	35%
Medica	$433	35%
Student Ins/Mega Life	$433	35%
UnitedHealthcare	$433	35%
Humana	$450 - $1,223	37%
Asr Cofinity	$501	41%
Cofinity Commercial	$501	41%
Cofinity Weyco	$501	41%
Core Source	$501	41%
Epoch Group	$501	41%
Health Partners	$501	41%
Hlthcomp Admin	$501	41%
Mid America	$501	41%
Molina Healthcare Of Mi	$655	54%
Care Resources	$1,100	90%
Insight Metro Care	$1,223	100%
Medicare (plans)	$1,223	100%
Molina Marketplace Commercial	$1,223	100%

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 $240.
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 University of Michigan Health - West 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.