CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Louis Childrens Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,928
Cash Discount Price: $8,766
vs. Medicare Baseline: 1.58x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Louis Childrens Hospital is $1,928. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,766. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.58x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$8,766

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,928

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: $8,766 (717%)

Insurance Median: $1,928 (158%)

Cash: $8,766 (717% of Medicare)

Ins. Median: $1,928 (158% 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
Aetna	$471 - $1,178	39%
UnitedHealthcare	$471 - $6,278	39%
Cox Health [757]	$495 - $1,237	40%
Medica [662]	$495 - $1,237	40%
Blue Cross Blue Shield	$1,178 - $2,847	96%
Essence Healthcare [221]	$1,178	96%
Humana	$1,178 - $3,856	96%
Cigna	$1,273 - $2,811	104%
Consociate [478]	$1,403 - $2,805	115%
Sarah Bush Lincoln [636]	$1,403 - $2,805	115%
Apwu Health Plan [216]	$1,405 - $2,811	115%
Nalc Health Benefit Plan [242]	$1,405 - $2,811	115%
Priority Health [648]	$1,405 - $2,811	115%
Cox Health Systems Insurance Company [220]	$1,423 - $2,847	116%
Allied Benefits [498]	$1,501 - $3,002	123%
Hope Trust [806]	$1,501 - $3,002	123%
Health Alliance [224]	$1,812 - $3,623	148%
Healthcare Sol Mercy [609]	$1,941 - $3,882	159%
Med-Pay [480]	$1,941 - $3,882	159%
Healthscope Benefits [258]	$2,070 - $6,278	169%
Medica [661]	$2,070 - $4,141	169%
Phcs [244]	$2,070 - $4,141	169%

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 $8,766.
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 St Louis Childrens 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.