CMS Price Transparency Data

Colonoscopy with biopsy

Facility: M Health Fairview Southdale Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,660
Cash Discount Price: $850
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at M Health Fairview Southdale Hospital is $1,660. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $850. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.36x the Medicare baseline. Located in 6401 France Avenue South, Edina, MN.

Cash / Self-Pay

$850

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,660

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: $850 (70%)

Insurance Median: $1,660 (136%)

Cash: $850 (70% of Medicare)

Ins. Median: $1,660 (136% 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
Health Partners	$133 - $3,534	11%
Itasca Medical Care	$133 - $1,174	11%
Primewest	$133 - $1,174	11%
South Country Health Alliance	$133 - $1,174	11%
Ucare	$136 - $2,697	11%
Medica	$143 - $2,264	12%
Hennepin Health	$151 - $1,188	12%
Blue Cross Blue Shield	$153 - $3,418	13%
Sanford Health Plan	$181 - $2,108	15%
Security Health Plan	$181 - $2,684	15%
UnitedHealthcare	$181 - $3,365	15%
Wellcare	$181 - $1,174	15%
America'S Ppo	$686 - $2,577	56%
First Health	$740 - $2,935	61%
Multiplan	$767 - $3,042	63%
Private Healthcare Systems	$767 - $3,042	63%
Wisconsin Physician Services	$812 - $3,221	66%

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 $850.
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 M Health Fairview Southdale 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.