CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kenmore Mercy Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$386

about 0.3× the $1,223 Medicare rate · typically $229–$790

modeled estimate · not a bill or quote

What this hospital charges insurers

$225

Below the fair price — a good deal

about $161 under the fair price · 0.2× Medicare

Medicare pays $1,223 Fair price $386 This hospital $225 Cash price $922 Hospital's list price $922

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

A typical price — 5 charge more and 3 charge less, among the 9 NY hospitals compared.

Cheapest $192 Priciest $370

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $386 (about 0.3× the $1,223 Medicare rate). Kenmore Mercy Hospital charges insurers about $225, or about $922 in cash — below the fair price — a good deal. Located in Kenmore, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$133 - $221	11%
Blue Cross Blue Shieldmajor	$162 - $345	13%
Aetnamajor	$199	16%
Cignamajor	$190 - $275	16%
Humanamajor	$199	16%
Amerigroup	$162	13%
Fidelis Care	$199 - $228	16%
Independent Health	$162 - $347	13%
Molina	$364	30%
MVP Health Care	$250	20%
UPMC Health Plan	$342	28%
WellCare	$199 - $209	16%
+ 16 smaller / regional plans	$162 - $780

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 922), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Kenmore Mercy Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Kenmore Mercy Hospital

Compare: Colonoscopy with biopsy at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.