Colonoscopy with biopsy
Facility: Saint John Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,150
- Cash Discount Price: $1,127
- vs. Medicare Baseline: 0.94x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $382 | 31% |
| UnitedHealthcare | $382 - $1,578 | 31% |
| Healthy Blue | $390 - $1,184 | 32% |
| Celtic | $390 - $1,804 | 32% |
| Blue Cross Blue Shield | $682 - $1,364 | 56% |
| Comp Alliance Workers Comp | $796 | 65% |
| Midland Care Connection | $1,127 | 92% |
| Medicare (plans) | $1,127 | 92% |
| Tricare | $1,127 | 92% |
| Aetna | $1,127 - $2,488 | 92% |
| Cigna | $1,127 | 92% |
| Kansas Superior Select | $1,150 | 94% |
| Corizon | $1,578 | 129% |
| Well Path | $1,578 | 129% |
| Employer Direct Healthcare | $1,578 | 129% |
| Centurion | $1,691 | 138% |
| Naphcare | $1,747 | 143% |
| Oha Networks | $1,817 | 149% |
| Worker Compensation | $1,873 | 153% |
Consumer Guidance & Cost Commentary
For the Colonoscopy with biopsy procedure (CPT 45380) at Saint John Hospital in Leavenworth, KS, the facility's cash price of $1,127 is significantly lower than the negotiated rates charged to most insurance plans. While the facility's cash rate aligns with the state average of $1,127, commercial payers such as UnitedHealthcare, Healthy Blue, and Celtic have negotiated rates ranging from $382 to $2,488, with many plans falling between $1,127 and $1,873. Patients with high-deductible plans may find the cash price advantageous, as the negotiated rates for many insurers exceed the cash amount, potentially resulting in higher out-of-pocket costs if the patient's deductible has not yet been met. It is important to note that while the facility's cash rate matches the state median, the wide variance in negotiated rates across different payers suggests that specific insurance coverage can substantially impact the final cost.
The facility's pricing structure also reveals a notable relationship with Medicare, which serves as a benchmark for fair pricing. The Medicare amount for this service is $1,222.56, and the facility's cash rate of $1,127 is slightly below this federal baseline, indicating a competitive pricing model compared to the government's cost-based reimbursement. In contrast, the facility's gross charge of $6,202 represents a significant markup over both Medicare and cash rates, highlighting the importance of understanding the difference between the hospital's list price and the actual amounts paid by insurers or cash payers. Consumers are encouraged to verify their specific plan's allowed amount before scheduling, as some in