Colonoscopy with biopsy
Facility: Mcpherson Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,101
- Cash Discount Price: $1,013
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Wppa - All Plans | $958 | 78% |
| Tricare | $968 | 79% |
| Medical Associates - All Plans | $1,027 | 84% |
| Central Plains - All Plans | $1,027 | 84% |
| UnitedHealthcare | $1,068 - $1,369 | 87% |
| Christian Health Aid - All Plans | $1,095 | 90% |
| Blue Cross Blue Shield | $1,100 | 90% |
| Humana | $1,100 | 90% |
| Wellcare Mcr Adv - All Plans | $1,100 | 90% |
| Va Ccn - All Plans | $1,100 | 90% |
| Healthy Blue Mcr Adv | $1,100 | 90% |
| Aetna | $1,129 - $1,369 | 92% |
| Multiplan - All Plans | $1,232 | 101% |
| Ambetter / Centene | $1,266 | 104% |
| Health Partners - All Plans | $1,301 | 106% |
| Cigna | $1,301 | 106% |
| First Health - All Plans | $1,301 | 106% |
| Medicaid / KanCare | $1,369 | 112% |
| Health Blue Mcaid - All Other Plans | $1,396 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, McPherson Hospital in Kansas lists a gross charge of $1,369. The facility's cash median rate is $1,013, while the median negotiated rate paid by insurance plans is $1,101. This cash price is notably lower than the facility's gross charge, and patients with high-deductible plans may find paying out-of-pocket at the cash rate more cost-effective than relying on insurance, which often incurs administrative overhead that inflates the baseline price by 20% to 40%. Although specific state or county average data was not provided in the source material, the facility's cash rate of $1,013 serves as a direct benchmark for self-pay patients, and the median negotiated rate of $1,101 reflects the contractual ceiling set by the 19 unique payers listed, ranging from $958 for WPPA to $1,396 for Health Blue Medicaid.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is essential to verify network status before scheduling to avoid unexpected ancillary charges. If a patient chooses to pay directly, they should explicitly request a "self-pay" or "prompt-pay" discount prior to check-in, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass costly claims processing. Furthermore, because over 80% of hospital bills contain errors, patients should demand a full itemized CPT-coded statement rather than accepting a summary bill