CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Duke University Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $920
Cash Discount Price: $1,200
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Duke University Hospital is $920. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,200. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.75x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$1,200

Average discount available for prompt cash payment at this facility.

Insurance Median

$920

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: $1,200 (98%)

Insurance Median: $920 (75%)

Cash: $1,200 (98% of Medicare)

Ins. Median: $920 (75% 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	$87 - $3,152	7%
UnitedHealthcare	$92 - $7,755	8%
Humana	$94 - $3,409	8%
Blue Cross Blue Shield	$97 - $2,079	8%
Piedmont Health	$169	14%
Troy Health	$169 - $1,148	14%
Voans	$169 - $1,148	14%
Cigna	$173 - $4,011	14%
Liberty	$173 - $1,171	14%
Amerihealth	$175 - $1,008	14%
Carolina Complete Health	$175 - $1,008	14%
Alliance Health	$201 - $1,008	16%
Partners	$201 - $1,008	16%
Trillium	$201 - $1,008	16%
Sentara	$518 - $2,499	42%
Medcost	$1,709	140%

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 $1,200.
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 Duke University 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.