Colonoscopy with biopsy
Facility: Nmc Health
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,086
- Cash Discount Price: $1,523
- vs. Medicare Baseline: 0.89x 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 |
|---|---|---|
| Bluestem Pace | $161 - $1,086 | 13% |
| Leading Age | $258 - $1,737 | 21% |
| Medicaid / KanCare | $258 - $1,737 | 21% |
| Wppa | $538 - $1,854 | 44% |
| Occunet | $587 - $2,023 | 48% |
| Medincrease Health Plan | $636 - $2,191 | 52% |
| Samaritan Ministries International | $636 - $2,191 | 52% |
| Prime Health Services | $734 - $2,528 | 60% |
| Aetna | $807 - $4,852 | 66% |
| UnitedHealthcare | $881 - $3,034 | 72% |
| Cigna | $930 - $3,202 | 76% |
| Blue Cross Blue Shield | $1,364 | 112% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Nmc Health in Newton, Kansas, the facility's cash median price of $1,523 is notably lower than the state average for this procedure. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $807 to $3,034, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $1,523. It is important to note that the facility's negotiated rate of $1,086 represents the average amount paid across all plans, but individual contracts vary significantly; for instance, Blue Cross Blue Shield has a fixed negotiated rate of $1,364, while Medicaid / KanCare ranges from $258 to $1,737. Before scheduling, patients should explicitly request "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront, as these rates bypass the administrative overhead associated with insurance claims processing.
When reviewing the final invoice, consumers should avoid accepting summary bills that only show broad categories like "Laboratory" or "Pharmacy," as these can obscure errors or unbundled charges. Instead, always demand a full itemized CPT-coded statement to verify that services were rendered and that no double-billing occurred, since over 80% of hospital bills contain inaccuracies. This procedure should be compared against the Medicare benchmark of $1,222.56, which serves as the objective baseline for fair pricing; the facility's gross charge of $2,665 is significantly higher, highlighting