Colonoscopy with biopsy
Facility: Pratt Regional Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,411
- Cash Discount Price: $1,240
- vs. Medicare Baseline: 1.15x 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 |
|---|---|---|
| Christian Health Aid | $875 - $1,411 | 72% |
| UnitedHealthcare | $970 - $1,919 | 79% |
| Health Partners Of Kansas | $991 - $1,599 | 81% |
| Aetna | $1,049 - $1,693 | 86% |
| Celtic Insurance Company | $1,094 | 89% |
| Healthy Blue | $1,127 | 92% |
| Choicecare | $1,166 - $1,881 | 95% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Pratt Regional Medical Center in Pratt, KS, the cash price of $1,240 is lower than the facility's gross charge of $1,772. While the facility's negotiated rates range from $875 to $1,919 depending on the insurance plan, the cash price is notably lower than the highest negotiated rates found with payers like Choicecare ($1,881) and UnitedHealthcare ($1,919). This suggests that for patients with high-deductible plans or those without insurance, paying cash upfront could result in significant savings compared to using an out-of-network provider or facing a negotiated rate that exceeds the cash price. Patients should verify if their specific plan allows for self-pay discounts or prompt-pay incentives before scheduling, as these programs can further reduce the final amount owed.
The facility's pricing is benchmarked against Medicare, which sets a baseline rate of $1,222.56 for this procedure. The cash price of $1,240 is slightly above the Medicare amount, indicating a markup that is consistent with fair pricing standards rather than excessive commercial markups. It is important to note that while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If a patient receives a summary bill, they should demand a full line-by-line statement to identify any errors, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.