Colonoscopy with biopsy
Facility: Susan B Allen Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $554
- Cash Discount Price: $2,140
- vs. Medicare Baseline: 0.45x 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 |
|---|---|---|
| UnitedHealthcare | $350 | 29% |
| Providrs Care | $757 | 62% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $2,140, which is lower than the facility's gross charge of $3,292. While the hospital's negotiated rates with UnitedHealthcare and Providrs Care are $350 and $757 respectively, these amounts are significantly lower than the cash price, meaning patients with high-deductible plans might find paying out-of-pocket cheaper if their insurance allowed amount exceeds the cash rate. It is important to note that the facility's negotiated rates are well below the state average, but patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
The Medicare benchmark for this service is $1,222.56, which serves as a baseline for evaluating the facility's pricing; commercial rates often exceed this by 200% to 300%, though fair pricing is typically defined as 120% to 150% of the Medicare amount. If you receive a bill that includes charges for services not rendered, unbundled codes, or items that were cancelled, you should request a full itemized audit before paying, as over 80% of hospital bills contain errors. Additionally, if you are billed for out-of-network services at an in-network facility, the No Surprises Act may protect you from balance billing, so you should dispute any unexpected charges immediately rather than accepting summary bills or signing away your rights without reading the terms.