CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Highland Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $601
Cash Discount Price: $4,973
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Highland Hospital is $601. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,973. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.49x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$4,973

Average discount available for prompt cash payment at this facility.

Insurance Median

$601

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: $4,973 (407%)

Insurance Median: $601 (49%)

Cash: $4,973 (407% of Medicare)

Ins. Median: $601 (49% 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
Medicaid / KanCare	$137 - $4,707	11%
Aetna	$158 - $1,814	13%
Excellus Bc/Bs [2201]	$158 - $1,099	13%
Medicare (plans)	$158 - $1,932	13%
Elderplan [1316]	$186 - $396	15%
Icircle [1728]	$186 - $396	15%
Martins Point [1205]	$186 - $1,494	15%
Nascentia [1729]	$186 - $396	15%
UnitedHealthcare	$186 - $4,707	15%
Humana	$187 - $1,786	15%
Fidelis [5155]	$224 - $4,707	18%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$245 - $1,744	20%
Highmark Bc/Bs Of Western Ny [5143]	$296 - $755	24%
Mvp [2900]	$339 - $3,935	28%
Independent Health [5156]	$386 - $826	32%
Cigna	$443 - $4,355	36%
Capital District Physicians Health Plan (Cdphp) [5149]	$486 - $1,427	40%
Amerigroup (Bswny Alternate) [1720]	$603 - $4,707	49%
Excellus [2201]	$603	49%
Blue Cross Blue Shield	$1,494 - $2,129	122%
Molina Healthcare [5189], Molina Healthcare [1723]	$1,543 - $4,707	126%

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 $4,973.
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 Highland 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.