CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Elizabethtown Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $910
Cash Discount Price: $2,215
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Elizabethtown Community Hospital is $910. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,215. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.74x the Medicare baseline. Located in 75 Park Street, Elizabethtown, NY.

Cash / Self-Pay

$2,215

Average discount available for prompt cash payment at this facility.

Insurance Median

$910

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: $2,215 (181%)

Insurance Median: $910 (74%)

Cash: $2,215 (181% of Medicare)

Ins. Median: $910 (74% 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
Fidelis Care	$158 - $1,220	13%
Mvp	$158 - $2,507	13%
Humana	$176 - $1,120	14%
Aetna	$186 - $2,408	15%
Blue Cross Blue Shield	$186 - $2,413	15%
Veterans Affairs Community Care Network	$186 - $1,220	15%
Choicecare	$204 - $2,568	17%
Wellpath	$260 - $1,830	21%
Capital District Physicians' Health Plan	$269 - $1,220	22%
UnitedHealthcare	$277 - $2,956	23%
Martins Point	$396 - $1,220	32%
Highmark Blueshield	$650 - $2,616	53%
Harvard Pilgrim	$975 - $2,568	80%
Magnacare	$975 - $2,568	80%
Coventry	$1,036 - $2,728	85%
Multiplan	$1,097 - $2,889	90%
Emblem Health	$2,568	210%

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 $2,215.
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 Elizabethtown Community 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.