Colonoscopy with biopsy
Facility: Centura St. Catherine-Dodge City
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $180
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.15x 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 |
|---|---|---|
| Medicare (plans) | $180 | 15% |
| Aetna | $180 | 15% |
| Kaiser | $180 | 15% |
| Blue Cross Blue Shield | $180 | 15% |
| Kansas Health | $180 | 15% |
| Cigna | $180 | 15% |
| Humana | $180 | 15% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Centura St. Catherine-Dodge City in Dodge City, KS, the negotiated rate across seven payers is a flat $180. This amount aligns exactly with the state and county average for this procedure, indicating no deviation from regional pricing norms. While Medicare sets a benchmark of $1,222.56, the commercial negotiated rate of $180 represents a significant reduction from the federal baseline, reflecting the typical administrative markup structure where commercial rates often range between 120% and 150% of Medicare costs rather than the higher 200% to 300% markups sometimes seen. Patients should note that this $180 figure is the maximum allowed by insurers; if a patient has a high-deductible plan, paying the cash price directly could result in lower out-of-pocket costs if the insurer's allowed amount exceeds the cash rate, though current data shows the negotiated rate is already the primary benchmark.
It is important to distinguish between the negotiated rate and potential cash-pay options. Although the data does not list a specific cash median, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment. These discounts bypass the costly insurance claims process, saving the facility administrative fees that often inflate the final bill. If a patient receives a bill significantly higher than the $180 negotiated rate, it may be due to balance billing from out-of-network ancillary services or errors in the itemized statement. In such cases, patients should request a full, line-by-line itemized audit to identify unbundled