Colonoscopy with biopsy
Facility: Saint Luke'S South Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $2,266
- Cash Discount Price: $7,783
- vs. Medicare Baseline: 1.85x 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 |
|---|---|---|
| Medicaid / KanCare | $382 - $1,005 | 31% |
| Humana | $1,350 - $3,029 | 110% |
| Cigna | $1,350 - $6,179 | 110% |
| UnitedHealthcare | $1,393 - $2,326 | 114% |
| Commercial-Contracted [8000] | $1,811 | 148% |
| Blue Cross Blue Shield | $2,814 - $3,309 | 230% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Saint Luke's South Hospital in Overland Park, Kansas, the facility's cash median price is $7,783, which is significantly lower than the state average for this procedure. While commercial insurance plans like Humana and Cigna have negotiated rates ranging from $1,350 to $6,179, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket if they qualify for a self-pay or prompt-pay discount. It is important to note that while the facility is in-network for these payers, the administrative costs and contract structures can inflate the final billed amount compared to direct payment, so verifying the specific allowed amount before scheduling is essential to avoid unexpected costs.
The facility's Medicare benchmarking ratio of 1.9 indicates that the commercial rates charged are nearly double the federal government's fixed reimbursement rate of $1,222.56, which serves as a scientifically validated baseline for the true cost of care. This markup highlights that comparing rates to the hospital's gross chargemaster list can be misleading, as the actual negotiated rates for in-network patients are often closer to the Medicare benchmark when adjusted for local wage indexes. To ensure you are receiving fair pricing, we recommend requesting a full itemized billing audit to identify any unbundled codes or services not rendered, and disputing any balance bills immediately if they arise from out-of-network ancillary services, as federal protections under the No Surprises Act may apply.