CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kaleida Health

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,598
Cash Discount Price: $1,298
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Kaleida Health is $1,598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,298. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.31x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$1,298

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,598

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: $1,298 (106%)

Insurance Median: $1,598 (131%)

Cash: $1,298 (106% of Medicare)

Ins. Median: $1,598 (131% 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
Ghi/Emblem Health	$223 - $2,017	18%
Ghi/Emblem Health - Wchob	$223 - $278	18%
Aetna	$232 - $3,205	19%
Magnacare	$232 - $2,995	19%
Magnacare - Wchob	$232 - $2,995	19%
Univera	$736 - $2,082	60%
Univera - Wchob	$736 - $2,024	60%
Independent Health Association	$869 - $2,364	71%
Independent Health Association - Wchob	$902 - $2,422	74%
Blue Cross Blue Shield	$1,019 - $5,574	83%
Tricare	$1,419	116%
Wellcare	$1,554	127%
Fidelis	$1,613	132%
UnitedHealthcare	$1,621	133%
Cigna	$1,748 - $2,121	143%

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 $1,298.
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 Kaleida 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.