CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Essentia Health St Mary's Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45380
  • Insurance Median: $1,532
  • Cash Discount Price: $2,022
  • vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Essentia Health St Mary's Medical Center is $1,532. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,022. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.25x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.
Cash / Self-Pay
$2,022

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,532

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: $2,022 (165%)
Insurance Median: $1,532 (125%)
Cash: $2,022 (165% of Medicare)
Ins. Median: $1,532 (125% 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.

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
Medica Access $1,014 83%
Primewest $1,138 93%
Itasca Med Care $1,179 96%
Advocare/Security Health $1,183 97%
Blue Cross Blue Shield $1,183 - $2,329 97%
Freedom Blue Ppo $1,183 97%
Healthpartners Care Msho / Mcr Adv $1,183 97%
Imcare Msho (Ref Req) $1,183 97%
Imcare Msho Pcc Prime $1,183 97%
Imcare Msho Ref Req $1,183 97%
Medica Advantage Solutions $1,183 97%
Medica Msho/Dual Solutions $1,183 97%
Medica Prime Solution Group $1,183 97%
Medicare (plans) $1,183 97%
Nd Va Administration $1,183 97%
Platinum Blue / Vantage Blue $1,183 97%
Primewest Msho $1,183 97%
Secure Blue Msho $1,183 97%
Ubh Cost Plan $1,183 97%
Ubh Msho $1,183 97%
Ucare Msho $1,183 97%
UnitedHealthcare $1,183 - $2,243 97%
Healthpartners Care Pmap $1,219 100%
Sanford Health Plan $1,314 - $2,088 107%
Blue Plus Pmap Pcc Prime $1,353 - $1,532 111%
Medica $1,694 - $1,740 139%
Medica Uplan $1,694 139%
Healthpartners $1,835 - $2,191 150%
Medica Choice $1,872 153%
Ucare $2,016 165%
Cigna $2,191 179%
Healthpartners Pcc Prime $2,191 179%
Wea $2,206 - $2,359 180%
Security Health $2,359 193%
America'S Ppo $2,375 194%
Wps $2,543 - $2,574 208%
Aetna $2,604 213%
Healthscope Benefits $2,604 213%
Healtheos $2,635 216%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 402 East Second Street, Duluth, MN 55805
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals