Colonoscopy with biopsy
Facility: Nemaha Valley Community Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $450
- Cash Discount Price: $860
- vs. Medicare Baseline: 0.37x 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 |
|---|---|---|
| Va Ccn - All Plans | $166 | 14% |
| Humana | $166 - $440 | 14% |
| Aetna | $168 - $850 | 14% |
| Celtic Comm Exch - All Plans | $174 - $329 | 14% |
| Partners Direct Health - All Plans | $183 - $520 | 15% |
| Midlands Choice - All Plans | $460 - $950 | 38% |
| Blue Cross Blue Shield | $476 | 39% |
| Multiplan - All Plans | $546 - $900 | 45% |
| Health Partners - All Plans | $795 - $950 | 65% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median rate of $860.00 is lower than the state average of $955.00, making it a cost-effective option for patients paying out-of-pocket. While the facility's negotiated rates with insurers like Humana and Aetna range from $166 to $950, these amounts often exceed the cash price, which can be advantageous for patients with high-deductible plans who have not yet met their coverage thresholds. 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 verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce the final cost.
The facility's Medicare benchmark of $1,222.56 serves as a reliable baseline for evaluating pricing, as commercial negotiated rates typically average between 200% and 300% of this amount, whereas fair pricing is generally defined as 120% to 150%. In this case, the median negotiated rate of $450.00 falls below the Medicare benchmark, indicating a competitive rate structure compared to the federal standard. However, patients should be cautious of summary bills that obscure individual charges; if an itemized audit reveals unbundled codes or services not rendered, a formal written dispute should be sent to the billing supervisor to ensure accuracy. Ultimately, comparing the cash price against your specific insurance allowed amount is the most effective way to determine the true cost of care.