CMS Price Transparency Data

Colonoscopy with biopsy

Facility: The University of Vermont Health Network - Champl

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $922
Cash Discount Price: $3,215
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at The University of Vermont Health Network - Champl is $922. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,215. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.75x the Medicare baseline. Located in 75 Beekman Street, Plattsburgh, NY.

Cash / Self-Pay

$3,215

Average discount available for prompt cash payment at this facility.

Insurance Median

$922

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: $3,215 (263%)

Insurance Median: $922 (75%)

Cash: $3,215 (263% of Medicare)

Ins. Median: $922 (75% 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
Mvp	$158 - $3,960	13%
Aetna	$186 - $3,547	15%
Blue Cross Blue Shield	$186 - $6,841	15%
Fidelis Care	$186 - $1,441	15%
Humana	$186 - $1,369	15%
Veterans Affairs Community Care Network	$186 - $1,441	15%
Wellpath	$260 - $2,161	21%
UnitedHealthcare	$277 - $3,796	23%
Capital District Physicians' Health Plan	$396 - $3,922	32%
Martins Point	$396 - $1,543	32%
Highmark Blueshield	$650 - $3,295	53%
Harvard Pilgrim	$1,163 - $3,980	95%
Magnacare	$1,163 - $3,980	95%
St. Regis	$1,163 - $1,441	95%
Coventry	$1,309 - $4,478	107%
Multiplan	$1,381 - $4,726	113%
Emblem Health	$3,980	326%

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 $3,215.
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 The University of Vermont Health Network - Champl 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.