CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kenmore Mercy Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $190
Cash Discount Price: $922
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Kenmore Mercy Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $922. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.16x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$922

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

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: $922 (75%)

Insurance Median: $190 (16%)

Cash: $922 (75% of Medicare)

Ins. Median: $190 (16% 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	$133 - $221	11%
Medicaid / KanCare	$154 - $190	13%
Vna Option Mltc [350110]	$162	13%
Excellus Rochester McD [350117]	$162	13%
Tuscarora Nation [550120]	$162	13%
Amerigroup [350102]	$162	13%
Independent Health Essential [100166]	$162	13%
Crime Victims [100176]	$162	13%
Blue Cross Blue Shield	$162 - $345	13%
Univera Healthcare Essential [100170]	$164	13%
Univera Healthcare [100169]	$164 - $299	13%
Beacon Essential [350122]	$171 - $228	14%
VA Veterans Affairs [700001]	$171	14%
Medicare (plans)	$187 - $413	15%
Hospice [550001]	$190	16%
Catholic Health Life Pace [400005]	$190	16%
Cigna	$190 - $275	16%
Champ VA [700002]	$190	16%
Covid19 Hrsa [45013]	$190	16%
Tricare	$190	16%
Seneca Nation [450119]	$190	16%
Fallon Health [450115]	$190	16%
Fidelis Dual Advantage [450120]	$199	16%
Aetna	$199	16%
Humana	$199	16%
Wellcare Fidelis Dual [450451]	$199	16%
Wellcare [450129]	$209	17%
Ghi [100153]	$209	17%
Fidelis Essential [100163]	$209	17%
Beacon Health Options [100023]	$228	19%
Fidelis Exchange [100164]	$228	19%
Mvp Healthcare [100168]	$250	20%
UPMC Health Plan [100181]	$342	28%
Independent Health [100165]	$347	28%
Iha First Choice [800001]	$347	28%
Molina Essential [100167]	$364	30%
Federal Workers Compensation [500100]	$780	64%
No Fault [114001]	$780	64%

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 $922.
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 Kenmore Mercy 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.