Colonoscopy with biopsy
Facility: Holton Community Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,084
- Cash Discount Price: $1,094
- vs. Medicare Baseline: 0.89x 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 |
|---|---|---|
| Aetna | $166 - $2,025 | 14% |
| UnitedHealthcare | $166 - $2,025 | 14% |
| Humana | $168 - $1,084 | 14% |
| Kansas Superior Select - All Plans | $169 - $1,095 | 14% |
| Medicaid / KanCare | $225 - $2,025 | 18% |
| Blue Cross Blue Shield | $1,350 | 110% |
| Preferred Health Professionals | $1,681 | 137% |
| Preferred Health Freedom | $1,681 | 137% |
| Preferred Health Fn Select - All Other Plans | $1,681 | 137% |
| Wppa Providers - All Plans | $1,924 | 157% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Holton Community Hospital in Holton, Kansas, the cash price is $1,094, which is lower than the facility's gross charge of $1,459. While the median negotiated rate across ten payers is $1,681, patients with high-deductible plans might find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the true cost of care; in this case, the Medicare benchmark of $1,222.56 serves as a more accurate baseline for evaluating fair pricing than the facility's inflated list price.
Although the data does not provide specific county or state average comparisons for this procedure, the facility's cash rate of $1,094 remains a strong reference point for self-pay patients. To minimize costs, consumers should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, if you have insurance, be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, meaning you should not feel pressured to pay the difference between the hospital's chargemaster and your insurance allowed amount without first disputing the bill in writing.