CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Porter Hospital Inc

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $737
Cash Discount Price: $2,181
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Porter Hospital Inc is $737. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,181. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.60x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$2,181

Average discount available for prompt cash payment at this facility.

Insurance Median

$737

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: $2,181 (178%)

Insurance Median: $737 (60%)

Cash: $2,181 (178% of Medicare)

Ins. Median: $737 (60% 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	$157 - $3,428	13%
Fidelis Care	$167 - $1,556	14%
Humana	$176 - $1,120	14%
Aetna	$185 - $1,729	15%
Veterans Affairs Community Care Network	$185 - $1,729	15%
Veterans Choice	$185 - $1,729	15%
Blue Cross Blue Shield	$213 - $3,196	17%
Harvard Pilgrim	$221 - $2,942	18%
Coventry	$241 - $3,237	20%
UnitedHealthcare	$277 - $3,641	23%
Wellpath	$376 - $2,023	31%
Capital District Physicians' Health Plan	$396 - $3,067	32%
Martins Point	$405 - $1,729	33%
Medical Corporation	$649 - $3,494	53%
Multiplan	$649 - $3,494	53%
Cigna	$677 - $3,345	55%

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 $2,181.
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 Porter Hospital Inc 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.