CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Carlsbad Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,650
Cash Discount Price: $1,711
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Carlsbad Medical Center is $1,650. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,711. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.35x the Medicare baseline. Located in 2430 West Pierce Street, Carlsbad, NM.

Cash / Self-Pay

$1,711

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,650

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: $1,711 (140%)

Insurance Median: $1,650 (135%)

Cash: $1,711 (140% of Medicare)

Ins. Median: $1,650 (135% 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
Veterans Eval Services	$391	32%
Blue Cross Blue Shield	$744 - $15,447	61%
Medicaid / KanCare	$744 - $1,078	61%
UnitedHealthcare	$820 - $11,327	67%
Department Of Veterans Affairs	$1,185	97%
Tricare	$1,185	97%
Medicare (plans)	$1,248	102%
Node Molina Mcr Adv	$1,248	102%
Presbyterian	$1,248 - $12,366	102%
Node Va	$1,269	104%
Triwest	$1,269	104%
Node Choice Care Mcr Adv	$1,311	107%
Node Devoted Health Mcr Adv	$1,311	107%
Us Department Of Labor	$1,586	130%
Wexford Health	$1,586	130%
Work Comp Nm	$1,589	130%
Self Pay	$1,711	140%
Node Molina Health Exchange	$3,464	283%
Nm Health Connection	$5,075	415%
Cigna	$8,555 - $14,339	700%
Eddy County Detention	$8,555	700%
Zelis	$10,780 - $14,373	882%
Omni Network	$11,122	910%
Capstar	$11,293	924%
Choice Care	$11,977	980%
Ccn First Health	$13,688	1120%
Healthsmart	$13,860 - $14,715	1134%
Aetna	$14,373	1176%
Multiplan	$14,373	1176%
Medical Control Inc	$15,913	1302%

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 $1,711.
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 Carlsbad Medical Center 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.