CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Astria Sunnyside Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,023
Cash Discount Price: $2,243
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Astria Sunnyside Hospital is $2,023. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,243. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.65x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$2,243

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,023

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: $2,243 (183%)

Insurance Median: $2,023 (165%)

Cash: $2,243 (183% of Medicare)

Ins. Median: $2,023 (165% 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
Medicare (plans)	$227 - $994	19%
Aetna	$965 - $3,463	79%
Healthcomp_Ihs	$965	79%
Humana	$965 - $3,542	79%
Medicaid / KanCare	$965 - $1,206	79%
Molina	$965	79%
Va	$965	79%
Tricare	$975	80%
Regence	$2,023	165%
Cigna	$2,361	193%
Li	$2,416	198%
First_Choice	$2,951	241%
Tpsc	$3,069	251%
Kaiser	$3,090	253%
Premera	$3,203	262%
UnitedHealthcare	$3,345	274%
Fhpw	$3,463	283%
Healthcomp	$3,542	290%
Bcchp	$3,935	322%
Great_Rivers	$3,935	322%
Zenith	$3,935	322%

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 $2,243.
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 Sunnyside 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.