Colonoscopy with biopsy
Facility: Wesley Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,816
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.49x 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 | $382 | 31% |
| Medicaid / KanCare | $394 | 32% |
| Amerigroup | $398 | 33% |
| Aetna | $398 - $2,454 | 33% |
| Usa Managed Care | $711 | 58% |
| First Health | $1,779 | 146% |
| Multiplan | $1,854 | 152% |
| United | $2,704 | 221% |
| Blue Cross Blue Shield | $2,795 | 229% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Wesley Medical Center in Wichita, KS, the facility's negotiated rates range from $382 to $2,795 depending on the insurance carrier. While the median negotiated amount across payers is $1,816, this figure is significantly higher than the Medicare benchmark of $1,222.56, indicating a markup of 1.5 times the federal rate. It is important to note that cash-pay options are not listed for this service, meaning patients without insurance coverage cannot utilize potential self-pay discounts. However, for those with high-deductible plans where the insurance allowed amount might exceed the facility's cash price, paying out-of-pocket could theoretically result in lower out-of-pocket costs, though this requires direct verification with the hospital regarding their specific self-pay or prompt-pay discount structures.
Patients should be aware that commercial insurance rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark. If you receive a bill that appears to include balance billing—where the provider charges the difference between their full list price and what your insurance paid—remember that the No Surprises Act generally prohibits this for emergency care and non-emergency services at in-network facilities. Furthermore, if you receive a summary bill, you have the right to request a full itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. Always verify your deductible status before scheduling, as paying with insurance may not reduce your cost if you have not yet met your plan's threshold.