Colonoscopy with biopsy
Facility: Hamilton County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $386
- Cash Discount Price: $407
- vs. Medicare Baseline: 0.32x 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 |
|---|---|---|
| First Health Coventry - All Plans | $346 | 28% |
| Aetna | $366 | 30% |
| Cigna | $386 | 32% |
| UnitedHealthcare | $386 | 32% |
| Blue Cross Blue Shield | $641 - $1,364 | 52% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Hamilton County Hospital in Syracuse, KS, the cash price is $407.00, which matches the facility's median negotiated rate of $386.00 and the state average. While this facility is a Critical Access Hospital with government ownership, patients should be aware that commercial insurance rates can sometimes exceed cash prices due to administrative overhead and contract structures. In this specific case, the cash price is slightly higher than the median negotiated rate of $386.00, meaning patients with high-deductible plans might save money by paying the cash price directly rather than relying on insurance, provided they have the funds available. It is always advisable to ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
The Medicare benchmark for this service is $1,222.56, which serves as a reliable baseline for evaluating pricing fairness. The commercial negotiated rates for this procedure range from $346 to $1,364 across five payers, with most plans settling around $386.00, which is significantly lower than the Medicare amount but higher than the cash price. This pricing structure highlights the importance of understanding that in-network rates are not always the lowest possible option; in fact, paying out-of-pocket can sometimes be more economical than the insurance allowed amount. If you receive a bill that seems unusually high, you should request an itemized audit to ensure no errors, such as unbundled codes or services not rendered, have inflated the total.