Colonoscopy with biopsy
Facility: Rawlins County Health Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,364
- Cash Discount Price: $1,713
- vs. Medicare Baseline: 1.12x 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 |
|---|---|---|
| UnitedHealthcare | $1,136 - $2,371 | 93% |
| Blue Cross Blue Shield | $1,364 | 112% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Rawlins County Health Center in Atwood, Kansas, the cash price is $1,713, which is lower than the facility's gross charge of $2,016. While UnitedHealthcare negotiates a rate range between $1,136 and $2,371 across four plans, and Blue Cross Blue Shield has a fixed negotiated rate of $1,364, patients with high-deductible plans might find paying the cash price directly more affordable if their insurance allowed amount exceeds this figure. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than cash prices; therefore, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not charged the full negotiated amount.
This procedure's pricing is evaluated against the Medicare benchmark of $1,222.56, with the cash price representing a 1.1x markup relative to that federal baseline. Although the data does not provide specific county or state average comparisons for this code, the facility operates as a Critical Access Hospital with a voluntary non-profit ownership structure. To avoid unexpected costs, patients should request an itemized bill to verify that no services were unbundled or double-charged, as over 80% of hospital bills contain errors. If a balance bill arises from an out-of-network ancillary service, patients should dispute the charge with their insurer under the No Surprises Act rather than paying immediately, and they should ensure they do not sign away their rights to dispute out-of-network fees via consent waivers.