CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Astria Toppenish Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,204
Cash Discount Price: $1,674
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Astria Toppenish Hospital is $1,204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,674. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.98x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$1,674

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,204

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: $1,674 (137%)

Insurance Median: $1,204 (98%)

Cash: $1,674 (137% of Medicare)

Ins. Median: $1,204 (98% 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	$186 - $3,367	15%
Premera_Affordable_Care	$458 - $1,484	37%
Chpw_Cascade_Care	$766 - $2,479	63%
First_Choice	$839 - $2,715	69%
Ambetter / Centene	$875	72%
UnitedHealthcare	$875 - $3,250	72%
Va	$875 - $1,035	72%
Molina	$892	73%
Medicare (plans)	$901 - $3,250	74%
Tpsc	$948 - $3,069	78%
Aetna	$1,070 - $3,463	88%
Li	$1,101	90%
Molina_Exchange	$1,137	93%
Cigna	$1,204	98%
Humana	$1,204 - $3,935	98%
Tricare	$1,204	98%
Bcchp	$1,216 - $3,935	99%
Great_Rivers	$1,216 - $3,935	99%
Healthcomp	$1,216 - $3,935	99%
Washington_State_Hca	$1,216 - $3,935	99%
Zenith	$1,216	99%
Regence	$1,334	109%
Premera	$1,484	121%
Kaiser	$4,213	345%

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 $1,674.
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 Astria Toppenish 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.