Colonoscopy with biopsy
Facility: Providence Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,184
- Cash Discount Price: $1,127
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Aetna | $300 - $2,488 | 25% |
| Medicaid / KanCare | $382 | 31% |
| UnitedHealthcare | $382 - $2,665 | 31% |
| Healthy Blue | $390 - $1,184 | 32% |
| Celtic | $390 - $1,804 | 32% |
| Comp Alliance - Fka Compresults Worker Compensation | $796 | 65% |
| Tricare | $1,127 | 92% |
| Medicare (plans) | $1,127 | 92% |
| Cigna | $1,127 | 92% |
| Midland Care Connection | $1,127 | 92% |
| Kansas Superior Select | $1,184 | 97% |
| Corizon | $1,466 | 120% |
| Employer Direct Healthcare | $1,578 | 129% |
| Well Path Prison | $1,578 | 129% |
| Centurion | $1,691 | 138% |
| Naphcare | $1,747 | 143% |
| Blue Cross Blue Shield | $1,804 - $2,086 | 148% |
| Oha Networks | $1,817 | 149% |
| Worker Compensation | $1,873 | 153% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy at Providence Medical Center in Kansas City, KS, the facility's cash price is $1,127, which aligns exactly with the state average. While the facility's negotiated rates for commercial payers range from $300 to $2,665, these figures often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $1,127 upfront, as this avoids the higher negotiated amounts that insurance carriers typically pay, which can sometimes be significantly higher than the cash price. It is important to verify the specific allowed amount for your plan before scheduling, as in-network rates vary widely among the 19 payers listed, with some plans paying as low as $300 while others pay up to $2,665 for the same service.
To minimize costs, patients should proactively request a "prompt-pay" discount from the billing department if they choose to pay out-of-pocket, as hospitals often offer reductions of 20% to 50% for upfront payments to bypass costly claims processing. Additionally, since the facility is an in-network provider for many plans, the No Surprises Act protects patients from balance billing for out-of-network services rendered at this location, though it is still advisable to review the itemized bill to ensure no unbundled codes or services not rendered are included. The facility's Medicare benchmark rate of $1,222.56 serves as a reliable baseline for evaluating pricing; commercial negotiated rates generally average between 200% and 300