Colonoscopy with biopsy
Facility: Kansas City Orthopaedic Institute
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $2,723
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.23x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 223% of the Medicare baseline (a markup of 123%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $1,047 | 86% |
| Aetna | $1,047 | 86% |
| Cigna | $1,109 | 91% |
| Blue Cross Blue Shield | $2,723 | 223% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rate of $2,723 is significantly higher than the Medicare benchmark of $1,222.56, reflecting a markup of 2.2 times the federal rate. While this facility is in-network for UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield, the data indicates that the negotiated rate for this specific service is uniform across all four payers, meaning there is no variation in the allowed amount based on the specific insurance plan. It is important to note that commercial negotiated rates often include administrative overhead and contract premiums, which can inflate the final cost compared to the base Medicare reimbursement.
Patients should be aware that cash-pay options may offer a lower out-of-pocket cost if your insurance deductible has not yet been met, as paying the full negotiated rate could result in higher immediate expenses. Before scheduling, it is highly recommended to contact the facility directly to inquire about self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% for upfront payment. Additionally, since the facility is an acute care hospital with physician ownership, you may be able to negotiate the price further if you pay in full prior to the procedure. Always request an itemized bill and verify that no balance billing occurs, as federal protections under the No Surprises Act prevent unexpected charges for out-of-network services at in-network facilities.