Colonoscopy with biopsy
Facility: Graham County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,379
- Cash Discount Price: $1,760
- vs. Medicare Baseline: 1.13x 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 |
|---|---|---|
| Medicaid / KanCare | $612 | 50% |
| UnitedHealthcare | $612 - $1,672 | 50% |
| Medicare (plans) | $1,320 | 108% |
| Blue Cross Blue Shield | $1,350 | 110% |
| Celtic Commercial-All Other Plans | $1,452 | 119% |
| Wppa (Providers Care)-All Plans | $1,672 | 137% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Graham County Hospital in Hill City, Kansas, the cash price is $1,760.00, which matches the facility's median negotiated rate of $1,452.00 and the cash median. This cash price is significantly higher than the state average for this procedure, indicating that patients without insurance may find this service more expensive than the typical rate in Kansas. While the facility is a Critical Access Hospital owned by the local government, the lack of a published facility rating suggests further review of their pricing transparency. Patients should be aware that cash payments can sometimes be more cost-effective than using insurance if the negotiated rate exceeds the cash price, though in this specific case, the cash rate is the highest figure available.
To minimize costs, patients should actively request a self-pay or prompt-pay discount before scheduling their appointment, as hospitals often offer immediate fee reductions for upfront payments that bypass the administrative overhead of insurance claims. It is crucial to avoid accepting summary bills, which obscure individual charges, and instead demand a detailed, itemized statement to identify any unbundled codes or services not rendered. Furthermore, while Medicare allows a benchmark of $1,222.56 for this service, commercial payers negotiate rates that average between $612 and $1,672 depending on the plan; however, patients must verify their specific deductible status and allowed amounts, as paying a high negotiated rate without meeting a deductible can result in significant out-of-pocket expenses.