Colonoscopy with biopsy
Facility: Ashland Health Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,895
- Cash Discount Price: $1,516
- vs. Medicare Baseline: 1.55x 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 | $635 | 52% |
| Compalliance-All Plans | $1,516 | 124% |
| Health Partners Of Kansas-All Plans | $1,611 | 132% |
| Multiplan-All Plans | $1,857 | 152% |
| Medicare (plans) | $1,895 | 155% |
| Healthy Blue Mcr Adv - All Other Plans | $1,895 | 155% |
| Health Choice-All Plans | $1,895 | 155% |
| Aetna | $1,895 | 155% |
| Medicaid / KanCare | $1,895 | 155% |
| Medica Mcare - All Plans | $1,895 | 155% |
| UnitedHealthcare | $1,895 | 155% |
| Providers Care (Wppa)-All Plans | $2,842 | 232% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Ashland Health Center in Ashland, KS, lists a gross charge of $1,895.00. While the facility's cash median rate is $1,516.00, which is lower than the negotiated rates paid by most major payers, patients should be aware that commercial insurance contracts often result in higher allowed amounts. For instance, Blue Cross Blue Shield and Compalliance-All Plans have negotiated rates of $635.00 and $1,516.00 respectively, though many other insurers, including Medicare and UnitedHealthcare, align with the gross charge of $1,895.00. It is important to note that while cash payment may appear cheaper, patients with high-deductible plans might still face significant out-of-pocket costs if their insurance deductible has not been met, as the negotiated rate could exceed the cash price. Additionally, the facility is a Critical Access Hospital in Kansas, and while specific state or county average data is not provided in this report, the Medicare benchmark for this service is $1,222.56, indicating that the gross charge represents a significant markup over the federal baseline.
Patients should exercise caution regarding balance billing and billing errors, as these can lead to unexpected costs even when using insurance. Although the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is crucial to verify that all services rendered, including any emergency physicians or lab services, are covered under the same network protections. If a patient receives a large bill after insurance processing, they should request a formal item