Colonoscopy with biopsy
Facility: Ellsworth County Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,549
- Cash Discount Price: $1,721
- vs. Medicare Baseline: 1.27x 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 |
|---|---|---|
| Humana | $809 - $1,635 | 66% |
| Va Ccn-All Plans | $809 | 66% |
| Healthy Blue Mcr Adv | $809 | 66% |
| Triwest -All Plans | $809 | 66% |
| UnitedHealthcare | $1,119 - $1,721 | 92% |
| Blue Cross Blue Shield | $1,282 - $1,350 | 105% |
| Aetna | $1,549 | 127% |
| First Health - All Plans | $1,549 | 127% |
| Cigna | $1,635 | 134% |
| Coventry Mcaid-All Plans | $1,721 | 141% |
| Medicaid / KanCare | $1,721 | 141% |
| Healthy Blue Mcaid- All Other Plans | $1,721 | 141% |
| Providers Care-Wppa-All Plans | $2,582 | 211% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Ellsworth County Medical Center in Ellsworth, KS, the facility's cash price is $1,721.00, which matches the gross chargemaster rate and the median cash price reported for this service. While the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $1,282 to $1,721, these amounts are generally higher than the cash price. This pricing structure suggests that patients with high-deductible plans or those without insurance may save money by paying the cash price directly, as the negotiated rates often exceed the self-pay amount. It is important to note that while the facility is a Critical Access Hospital, patients should verify if their specific insurance plan has a lower allowed amount than the cash price before scheduling, as paying cash upfront can sometimes result in a lower out-of-pocket cost compared to the insurance negotiated rate.
The facility's billing practices align with standard industry benchmarks, where commercial negotiated rates frequently exceed the Medicare rate of $1,222.56 for this procedure. In this case, the cash price of $1,721.00 is approximately 1.3 times the Medicare amount, reflecting the typical markup found in commercial pricing. Patients should be aware that balance billing is not a concern here, as the cash price is fixed and does not depend on an out-of-network provider's full chargemaster rate. However, if a patient receives care from an out-of-network provider at this facility, they should check their No Surprises Act protections, as federal law bans balance billing for emergency and non-emergency services