CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Valley Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,403
Cash Discount Price: $4,146
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Valley Medical Center is $1,403. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,146. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.15x the Medicare baseline. Located in 400 S 43Rd St, Renton, WA.

Cash / Self-Pay

$4,146

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,403

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: $4,146 (339%)

Insurance Median: $1,403 (115%)

Cash: $4,146 (339% of Medicare)

Ins. Median: $1,403 (115% 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
Great West [190102]	$418	34%
Christian Brother Employee Benefit Trust [110100]	$497	41%
Pacificsource [130122]	$497	41%
Soundpath Health-Termed [210113]	$1,079	88%
Regence Blue Shield [170100]	$1,124	92%
Regence Uniform [130111]	$1,124	92%
Chpw Med Advantage [210102]	$1,390	114%
Humana	$1,390 - $1,417	114%
Medicare (plans)	$1,390 - $1,459	114%
Regence Medadvantage [210111]	$1,390	114%
UnitedHealthcare	$1,390 - $4,651	114%
Aetna	$1,403 - $4,239	115%
Chpw [130116]	$2,223	182%
Molina [130117]	$2,362	193%
First Choice [150134]	$3,261	267%
Cigna	$3,939	322%
Blue Cross Blue Shield	$3,958	324%
Kaiser Washington Contracted [130118]	$4,940	404%

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 $4,146.
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 Valley Medical Center 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.