Colonoscopy with biopsy
Facility: Kiowa County Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,364
- Cash Discount Price: $1,022
- vs. Medicare Baseline: 1.12x 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 |
|---|---|---|
| UnitedHealthcare | $424 - $1,875 | 35% |
| Health Partners Of Ks-All Plans | $466 - $1,650 | 38% |
| Aetna | $471 - $1,669 | 39% |
| Medica Prime Mcare Cost-All Plans | $471 - $1,669 | 39% |
| Blue Cross Blue Shield | $471 - $1,669 | 39% |
| Celtic Comml Exchange-All Other Plans | $471 - $1,669 | 39% |
| Humana | $471 - $1,669 | 39% |
| Medicaid / KanCare | $529 - $1,875 | 43% |
| Providrs Care/Wppa-All Plans | $794 - $2,812 | 65% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Kiowa County Memorial Hospital in Greensburg, KS, lists a gross charge of $1,202.00. This amount is significantly higher than the Medicare benchmark of $1,222.56, with a ratio of 1.1, indicating the facility's pricing is very close to the federal baseline for this service. While the facility is a Critical Access Hospital owned by the local government, patients should note that commercial negotiated rates for this procedure range widely across payers, from a low of $424 to a high of $2,812. For instance, UnitedHealthcare and Medicaid/KanCare have the highest maximum negotiated rates at $1,875 and $2,812 respectively, whereas some plans like Health Partners Of Ks-All Plans have a lower ceiling of $1,650.
When considering payment options, the cash median price is $1,022.00, which is lower than the facility's negotiated rates for most commercial payers. This suggests that patients with high-deductible plans or those without insurance might save money by paying cash directly, provided they confirm the "self-pay" or "prompt-pay" discount policies with the hospital before scheduling. It is important to verify that paying cash upfront does not inadvertently trigger an automatic insurance claim submission, which could void any cash discount and result in balance billing. To ensure you are receiving the best possible rate, always request an itemized bill to review the specific CPT codes and avoid paying for services that were not rendered or that were incorrectly bundled.