Colonoscopy with biopsy
Facility: Ellinwood District Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $835
- Cash Discount Price: $1,014
- vs. Medicare Baseline: 0.68x 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 |
|---|---|---|
| Humana | $455 - $1,214 | 37% |
| Aetna | $455 - $1,214 | 37% |
| Blue Cross Blue Shield | $455 - $1,214 | 37% |
| UnitedHealthcare | $455 - $1,214 | 37% |
| Cigna | $455 - $1,214 | 37% |
Consumer Guidance & Cost Commentary
For the Colonoscopy with biopsy procedure at Ellinwood District Hospital in Ellinwood, KS, the cash median price is $1,014, which is lower than the facility's gross charge of $1,193. While the hospital is a Critical Access Hospital owned by a Government Hospital District, patients with high-deductible plans may find the cash price advantageous if their insurance negotiated rate exceeds this amount. The median negotiated rate across five major payers, including Humana, Aetna, and Blue Cross Blue Shield, is $835, yet the median paid amount by insurers is $1,215. This discrepancy highlights that insurance billing often includes administrative overhead and deductible contributions, meaning the actual out-of-pocket cost for insured patients can be higher than the cash price.
To minimize unexpected costs, patients should verify their specific plan's allowed amount before scheduling, as commercial rates can vary significantly even within the same network. 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, summary bills often obscure individual charges, making an itemized audit essential to identify unbundled codes or services not rendered. Additionally, patients should proactively request self-pay or prompt-pay discounts prior to check-in, as these upfront payment incentives can bypass costly claims processing and reduce the final bill. Given that over 80% of hospital bills contain errors, requesting a detailed, line-by-line statement is the most effective way to ensure accuracy and avoid unnecessary debt.