CMS Price Transparency Data

Colonoscopy with biopsy

Facility: M Health Fairview St John's Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,756
Cash Discount Price: $1,132
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at M Health Fairview St John's Hospital is $1,756. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,132. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.44x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$1,132

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,756

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: $1,132 (93%)

Insurance Median: $1,756 (144%)

Cash: $1,132 (93% of Medicare)

Ins. Median: $1,756 (144% 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
Sanford Health Plan	$75 - $2,108	6%
Security Health Plan	$92 - $2,684	8%
America'S Ppo	$96 - $2,577	8%
First Health	$104 - $2,935	9%
Multiplan	$108 - $3,042	9%
Private Healthcare Systems	$108 - $3,042	9%
Wisconsin Physician Services	$114 - $3,221	9%
Health Partners	$133 - $3,534	11%
Primewest	$133 - $1,147	11%
South Country Health Alliance	$133 - $1,147	11%
Ucare	$136 - $2,636	11%
Medica	$143 - $2,264	12%
Blue Cross Blue Shield	$153 - $3,418	13%
Itasca Medical Care	$153 - $1,147	13%
UnitedHealthcare	$181 - $3,500	15%
Wellcare	$181 - $1,147	15%
Hennepin Health	$204 - $1,188	17%

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 $1,132.
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 St John's 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.