CMS Price Transparency Data

Colonoscopy with biopsy

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $624
Cash Discount Price: $3,339
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at The University of Vermont Health Network-Alice Hy is $624. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,339. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.51x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$3,339

Average discount available for prompt cash payment at this facility.

Insurance Median

$624

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: $3,339 (273%)

Insurance Median: $624 (51%)

Cash: $3,339 (273% of Medicare)

Ins. Median: $624 (51% 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 - $1,191	13%
Humana	$158 - $1,191	13%
Mvp	$158 - $1,743	13%
Aetna	$186 - $3,202	15%
Veterans Affairs Community Care Network	$186 - $1,191	15%
Blue Cross Blue Shield	$196 - $3,815	16%
Capital District Physicians' Health Plan	$269 - $3,497	22%
UnitedHealthcare	$277 - $9,020	23%
Martins Point	$396 - $1,191	32%
Choicecare	$423 - $2,792	35%
St. Regis	$1,163 - $1,191	95%
Magnacare	$2,364 - $2,978	193%
Highmark Blueshield	$2,896 - $3,336	237%

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 $3,339.
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-Alice Hy 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.