CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Columbia Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $454
Cash Discount Price: $1,003
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Columbia Memorial Hospital is $454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,003. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.37x the Medicare baseline. Located in 71 Prospect Avenue, Hudson, NY.

Cash / Self-Pay

$1,003

Average discount available for prompt cash payment at this facility.

Insurance Median

$454

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: $1,003 (82%)

Insurance Median: $454 (37%)

Cash: $1,003 (82% of Medicare)

Ins. Median: $454 (37% 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
UnitedHealthcare	$84 - $2,815	7%
Mvp	$146 - $1,948	12%
Cdphp	$149 - $3,816	12%
Medicare (plans)	$157 - $454	13%
Medicaid / KanCare	$162 - $928	13%
Blue Cross Blue Shield	$177 - $3,333	14%
Tricare	$177 - $454	14%
Hamaspik	$195 - $1,262	16%
Fidelis	$198 - $2,087	16%
Aetna	$215 - $3,094	18%
Blue Shield Highmark	$224 - $650	18%
Cigna	$270 - $587	22%
Emblem	$277 - $2,542	23%
Emblem Health Ghi	$286 - $622	23%
Magnacare	$986 - $2,610	81%
Multiplan	$1,152 - $3,051	94%
Herrington Diversified Pdh	$1,280 - $2,093	105%
Blue Shield	$2,028 - $2,814	166%
Empire Plan Nyship	$3,333	273%
Mvp Commercial	$8,795	719%

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 $1,003.
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 Columbia Memorial 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.