Colonoscopy with biopsy
Facility: Kansas Heart Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,103
- Cash Discount Price: $1,180
- 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 | $749 | 61% |
| UnitedHealthcare | $909 - $1,873 | 74% |
| Tricare | $992 | 81% |
| Blue Cross Blue Shield | $1,074 - $1,873 | 88% |
| Medicaid / KanCare | $1,103 - $1,873 | 90% |
| Celtic Mcr Adv | $1,103 | 90% |
| Humana | $1,103 | 90% |
| Multiplan - All Plans | $1,686 | 138% |
| Aetna | $1,826 - $1,873 | 149% |
| Celtic Mcaid - All Other Plans | $1,873 | 153% |
| Soonerselect Mcaid - All Plans | $1,873 | 153% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Kansas Heart Hospital in Wichita, KS, the facility's cash price of $1,180 is lower than the state average for this procedure. While the hospital's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $909 to $1,873, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket or seeking a prompt-pay discount before scheduling. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about self-pay or prompt-pay discounts to ensure they are receiving the most favorable rate available.
The facility's Medicare benchmark of $1,222.56 serves as a reliable baseline for evaluating pricing, as commercial negotiated rates frequently exceed this federal standard due to administrative costs and contract dynamics. For this service, the median negotiated rate across payers is $1,103, which is slightly below the Medicare amount, but individual payer rates can vary significantly, with some plans paying up to the gross charge of $1,873. To avoid unexpected costs, patients should request a full itemized bill before paying, as summary bills often obscure specific charges, and they should dispute any balance billing immediately if it occurs, rather than accepting the first invoice received.