CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Essentia Health Virginia

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,952
Cash Discount Price: $1,924
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Essentia Health Virginia is $1,952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,924. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.60x the Medicare baseline. Located in 901 9Th Street North, Virginia, MN.

Cash / Self-Pay

$1,924

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,952

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: $1,924 (157%)

Insurance Median: $1,952 (160%)

Cash: $1,924 (157% of Medicare)

Ins. Median: $1,952 (160% 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
Medica Access	$705	58%
Primewest	$1,138	93%
Advocare/Security Health	$1,157	95%
Blue Cross Blue Shield	$1,157 - $2,604	95%
Freedom Blue Ppo	$1,157	95%
Healthpartners Care Msho / Mcr Adv	$1,157	95%
Imcare Msho Pcc Prime	$1,157	95%
Imcare Msho Ref Req	$1,157	95%
Medica Advantage Solutions	$1,157	95%
Medica Msho/Dual Solutions	$1,157	95%
Medica Prime Solution Group	$1,157	95%
Medicare (plans)	$1,157	95%
Nd Va Administration	$1,157	95%
Platinum Blue/Vantage Blue	$1,157	95%
Primewest Msho	$1,157	95%
Secure Blue Msho	$1,157	95%
Ubh Cost Plan	$1,157	95%
Ubh Msho	$1,157	95%
Ucare Msho	$1,157	95%
UnitedHealthcare	$1,157 - $2,696	95%
Itasca Med Care	$1,179	96%
Healthpartners Care Pmap	$1,219	100%
Sanford Healthplan	$1,314 - $2,088	107%
Blue Plus Pmap Pcc Prime	$1,439 - $2,057	118%
Medica	$1,952 - $2,169	160%
Medica Uplan	$1,952	160%
Ucare	$2,016	165%
Healthpartners	$2,188 - $2,770	179%
Wea	$2,206 - $2,359	180%
Medica Choice	$2,234	183%
Security Health	$2,359	193%
America'S Ppo	$2,375	194%
Wps	$2,543 - $2,574	208%
Aetna	$2,604	213%
Cigna	$2,761 - $2,770	226%
Healthpartners Pcc Prime	$2,761 - $2,770	226%

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 $1,924.
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 Essentia Health Virginia 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.