Colonoscopy with biopsy
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,126
- Cash Discount Price: $4,788
- vs. Medicare Baseline: 0.92x 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 |
|---|---|---|
| Blue Cross Blue Shield | $180 - $1,275 | 15% |
| Indian Health Service Contracted [320198] | $180 | 15% |
| Provider Partners Health Plans Contracted [320450] | $198 | 16% |
| Medicaid / KanCare | $250 - $1,126 | 20% |
| Show-Me Health Administrators Contracted [320483] | $952 | 78% |
| Mercy Benefit Admin Contracted [320251] | $952 | 78% |
| UnitedHealthcare | $1,005 - $1,126 | 82% |
| Aetna | $1,069 - $1,126 | 87% |
| Medicare (plans) | $1,126 | 92% |
| Globalhealth Contracted [320145] | $1,126 | 92% |
| Mercy Mgd Behavioral Health Contracted [320259] | $1,126 | 92% |
| Cigna | $1,126 | 92% |
| Halo Hcr Inc Hospice [20432] | $1,126 | 92% |
| Mercy Hospice Okc [20252] | $1,126 | 92% |
| Qual Choice Contracted [320325] | $1,126 | 92% |
| Medical Associates Health Contracted [320444] | $1,126 | 92% |
| Tricare | $1,126 | 92% |
| Elara Caring Aspire Hospice [20433] | $1,126 | 92% |
| Pace Of The Ozarks Contracted [320518] | $1,126 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,126 | 92% |
| Kindful Hospice Contracted [320434] | $1,126 | 92% |
| Cross Timbers Hospice [20098] | $1,126 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $1,126 | 92% |
| Kindful Hospice [20434] | $1,126 | 92% |
| Centivo Contracted [320505] | $1,148 | 94% |
| Dept Of Veteran Affairs Contracted [320106] | $1,148 | 94% |
| Humana | $1,148 | 94% |
| Health Systems Inc Contracted [320174] | $1,354 | 111% |
| Benefit Management Contracted [320052] | $1,354 | 111% |
| Healthscope Contracted [320182] | $1,354 | 111% |
| Insurance System Inc Contracted [320465] | $1,354 | 111% |
| Point C Contracted [320238] | $1,354 | 111% |
| United Medical Resources Contracted [320454] | $1,354 | 111% |
| Health Choice Contracted [320166] | $2,004 | 164% |
| Providrs Care Network Contracted [320484] | $2,181 | 178% |
Consumer Guidance & Cost Commentary
For the Colonoscopy with biopsy (CPT 45380) at Mercy Specialty Hospital Southeast Kansas, the facility's cash price is $4,788, which is lower than the gross chargemaster rate of $7,366. While many commercial payers have negotiated rates ranging from $180 to $2,181, the cash price is notably lower than the median negotiated rate of $1,126 reported for this service. This price difference highlights a common billing dynamic where cash-pay options can be more affordable than insurance reimbursement for patients with high-deductible plans or those who have already met their out-of-pocket maximum. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated amount may not be cost-effective if the insurance payment is expected to be minimal. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative processing fees associated with insurance claims.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $1,222.56 for this procedure. The cash price of $4,788 represents a significant markup over the Medicare rate, illustrating how commercial rates often exceed the federal baseline due to administrative costs and contract structures. 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 request an itemized bill to ensure no unexpected charges for ancillary services or unbundled codes are included. If a patient receives a summary bill, they should demand a detailed line-by-line statement to identify any errors,