CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Perham Health

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $560
Cash Discount Price: $1,020
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Perham Health is $560. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,020. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.46x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$1,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$560

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: $1,020 (83%)

Insurance Median: $560 (46%)

Cash: $1,020 (83% of Medicare)

Ins. Median: $560 (46% 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
Ucare Mn Special Needs Basic Care Dual	$127 - $560	10%
Ucare Mn Medical Assistance	$140 - $565	11%
Ucare Mn Minnesota Care	$140 - $565	11%
Ucare Mn Senior Care Plus	$140 - $565	11%
Ucare Mn Special Needs Basic Care	$140 - $565	11%
Blue Cross Blue Shield	$169 - $2,383	14%
Health Partners Mcr Adv	$169 - $533	14%
Humana	$169 - $533	14%
Medicare (plans)	$169 - $628	14%
Medica Mcr Adv	$195 - $533	16%
Ucare Individual And Family Plan-All Other Plans	$204 - $784	17%
UnitedHealthcare	$215 - $1,569	18%
Ucare Mn Senior Health Options	$533 - $784	44%
Medicaid / KanCare	$566 - $1,616	46%
Medica Mcaid Mn Care	$574	47%
Medica Mn (Msho)	$646	53%
Sanford Health Plan-All Plans	$752 - $1,334	62%
Health Partners Minnesota Care	$784	64%
Medica Mn Senior Hp/Outside Mn	$800	65%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$863 - $1,177	71%
Medica Commercial-All Other Plans	$1,149	94%
Health Partners-All Plans	$1,287	105%
Preferred One (Ppo)	$1,334	109%

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 $1,020.
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 Perham Health 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.