Colonoscopy with biopsy
Facility: Kiowa District Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,791
- Cash Discount Price: $1,516
- vs. Medicare Baseline: 1.46x 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 |
|---|---|---|
| Tricare | $739 | 60% |
| Blue Cross Blue Shield | $1,350 | 110% |
| UnitedHealthcare | $1,516 - $1,895 | 124% |
| Health Partners Of Ks-All Plans | $1,668 | 136% |
| Healthchoice-All Plans | $1,707 | 140% |
| Humana | $1,710 | 140% |
| Gbs Insurance - All Plans | $1,781 | 146% |
| Multiplan-All Plans | $1,781 | 146% |
| Aetna | $1,800 | 147% |
| Triwest-All Plans | $1,800 | 147% |
| Medicare (plans) | $1,800 | 147% |
| Medicaid / KanCare | $1,895 | 155% |
| Providers Care (Wppa)-All Plans | $2,842 | 232% |
| Liberty Healthshare-All Plans | $3,060 | 250% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Kiowa District Hospital in Kiowa, KS, the cash median price is $1,516, which is lower than the facility's gross charge of $1,895. While the hospital is a Critical Access Hospital owned by a Government Hospital District, patients with high-deductible plans may find that paying cash upfront is more cost-effective than using insurance, as the negotiated rates for in-network payers range from $1,350 to $3,060. It is important to note that commercial negotiated rates often include administrative overhead and can exceed cash prices; therefore, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not charged the full insurance negotiated amount.
When comparing pricing to federal benchmarks, the Medicare amount for this service is $1,222.56, and the facility's cash rate of $1,516 represents a markup of 1.5 times the Medicare rate. This aligns with fair pricing standards, which typically range between 120% and 150% of Medicare, whereas commercial rates can sometimes reach 200% to 300% of the Medicare baseline. If you receive a bill that exceeds these benchmarks, you should request an itemized billing audit to identify potential errors such as code unbundling or services not rendered, as over 80% of hospital bills contain inaccuracies. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network providers at in-network facilities, so any unexpected charges should be disputed in